THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 

PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 
MRS.  PRUDENCE  W.  KOFOID 


HANDBOOK 


OF 


MEDICAL  MICROSCOPY. 


BY 

JOSEPH  G.  KICHARDSOST,  M.D., 

MICROSCOPIST  TO  THE   PENNSYLVANIA   HOSPITAL, 

Secretary  of  the  Biological  and  Microscopical  Section  of  the  Academy  of  Natural 
Sciences,  One  of  the  Assistant  Physicians  to  the  Episcopal  Hospital,  Fellow 
of  the  College  of  Physicians,  Member  of  the  Pathological  Society 
of  Philadelphia  ;  luto  Vice-President  of  the  Cnyuga  County 
Medical  Society,  New  York;  Corresponding  Mem- 
ber of  the  Gynaecological  Society  of  Boston  ; 
Permanent  Member  of  the  American 
Medical  Association,  etc.  etc. 


PHIL  ADELPH I A  : 

J.    B.    LIPPINCOTT    &    CO 
1871. 


Entered  according  to  Act  of  Congress,  in  the  year  1870,  by 

J.    B.    LIPPINCOTT    &    CO., 
In  the  Office  of  the  Librarian  of  Congress,  at  Washington. 


& 


TO  THE 

MANAGERS  OF  THE  PENNSYLVANIA  HOSPITAL, 

THROUGH    WHOSE    LIBERALITY 
II  AS   \\KKN  OBTAINED  A  LARGE  PART  OF  ITS  ILLUSTUATIVK  MATTKK, 


{]' his   1'it.Ic  | 


ork 
JS   RESPECTFULLY  DEDICATED 

JJY 


THE  AUTHOR. 


PREFACE. 


THIS  book  owes  its  origin  to  a  belief  entertained  by  the 
author  that  there  exist  in  the  profession  an  increasing  sense 
of  the  importance  of  microscopic  research,  and  a  grow- 
ing desire  to  render  its  advantages  available  in  the  routine 
of  daily  practice.  Estimating,  as  we  probably  may,  that 
at  least  one-half  the  cases  of  disease  which  physicians 
are  called  upon  to  treat,  would  have  some  light  thrown 
upon  their  nature  by  a  careful  examination  of  the  renal 
secretion,  sputum,  blood,  etc.  with  the  microscope,  it  seems 
obvious  that  an  earnest  and  conscientious  practitioner  of 
medicine  can  scarcely  discharge  his  whole  duty  to  himself 
and  his  patients  without  frequent  resort  to  such  investi- 
gations ;  and  in  order  to  promote  this  habit  among  medical 
men,  who  are  too  busy  to  search  through  the  elaborate 
and  expensive  manuals  already  before  the  public,  the 
following  pages  have  been  prepared,  with  special  refer- 
ence to  the  purely  practical  in  Microscopy.  In  order  to 
meet  the  demands  of  those  who,  from  any  cause,  have 
been  prevented  from  acquiring  or  retaining  a  due  famili- 
arity with  the  instrument  and  its  requisite  manipulations, 
a  constant  effort  has  been  made  to  describe  every  step  of 
the  processes  recommended,  great  care  being  taken  to 
enter  into  and  fully  elucidate  all  those  minute  but  im- 
portant details,  which,  because  they  seem  so  simple  to 
the  skillful  observer,  have  generally  been  passed  over 
without  particular  explanation.  Especial  attention  has 
also  been  paid  to  pointing  out  the  mistakes  into  which 
an  inexperienced  microscopist  is  liable  to  fall  from  errors 
of  observation  or  deduction. 

While  protesting  against  the  doctrines  of  that  French 
school  which  seems  to  vaunt  clinical  observation  by  the 

(v) 


vi  PREFACE. 

unaided  senses  alone,  the  author  has  continually  endeav- 
ored to  inculcate  the  use  of  the  microscope  only  as  an 
aid  to,  and  intimate  associate  with,  every  other  means  of 
investigating  disease,  as  has  been  his  custom  in  performing 
his  duties  of  Microscopist  to  the  Pennsylvania  Hospital 
in'  this  city,  the  unrivaled  clinical  advantages  of  which 
have  afforded  sundry  illustrative  cases  detailed  in  the  work. 
In  addition  to  this  original  material,  some  new  obser- 
vations upon  Albuminuria,  on  the  detection  of  Blood- 
stains, in  regard  to  the  identity  of  Salivary,  Pus,  and 
White  blood  corpuscles,  and  on  the  recognition  of  Lung- 
tissue  as  an  aid  to  the  early  diagnosis  of  Consumption, 
described  in  their  respective  places,  are  now  first  given  to 
the  profession  in  a  permanent  form. 

The  body  of  the  manual  is  arranged,  it  is  believed, 
more  thoroughly  than  any  previous  work  of  its  kind,  upon 
a  sort  of  natural  system,  and,  as  far  as  practicable,  in 
accordance  with  the  so-called  Dichotomous  plan,  having 
therefore  the  great  advantage  of  presenting  problems  of 
Diagnosis  as  they  occur  in  actual  practice.  By  this 
method,  as  will  be  seen  on  reference  to  the  Table  of  Con- 
tents and  to  Chapter  VII.,  while  different  secretions  and 
excretions  form  a  basis  of  classification,  classes  arc  divided, 
according  to  the  naked-eye  characteristics,  into  orders,  after 
which  the  microscopic  appearances  point  out  the  generic 
and  specific  peculiarities  that  serve  to  distinguish  the 
special  malady  existing,  and  so  conduce  to  those  great  ends, 
as  physicians  deem  them,  of  microscopic  study,  the  more 
accurate  Diagnosis,  Prognosis,  and  Treatment  of  disease. 

The  figures  contained  in  the  original  wood-cuts  are,  with 
one  or  two  trifling  exceptions,  Camera  Lucida  drawings 
from  actual  specimens,  and  all  exhibit,  as  accurately  as  the 
author's  delineations  have  sufficed  to  reproduce  them,  the 
exact  appearances  presented  to  the  eye  in  the  field  of  the 
microscope. 

No   1603  Arch  St.,  Philadelphia. 


CONTENTS. 


CHAPTER  I. 

l'.\ci: 

Tin-  Micri'si-i'jic  ...............................................................       '.» 


CHAPTER  II. 

In.-truiiH'iils,  Apparatus,  and  Manipulations  ........................     '•'>'•> 

CHAPTER   III. 

Examination  of  Urine. 

Division  1st.  Light  and  Flocculent  Deposits. 

Section  A.    Casts  of  the   Uriniferous   Tubules. 

Bright's  Disease  ......................................     67 

CHAPTER  IV. 

Section  B.     Other  Flocculent  Deposits  ..............     95 

CHAPTER  V. 

Division  '2d.     Dense  and  Bulky  Deposits  ...................   107 

CHAPTER  VI. 

Division  3d      Scanty  Granular  or  Crystalline  Deposits.  121 

CHAPTER  VII. 

Division  4th.     Substances  which  float  in  or  upon  the 

Fluid.     Recapitulation  and  Remarks  ..................  140 

CHAPTER  VIII. 

Examination  of  Pus,  Mueu.-.  Saliva,  and  Milk  ...........  .  ........   K>4 

(  vii  ) 


viii  COX  TEXTS. 

CHAPTER  IX. 

PAGE 

Examination  of  Blood 174 

CHAPTER  X. 

Examination  of  Sputum  in  Phthisis,  etc 198 

CHAPTER  XI. 
Examination  of  Vomited  Matters 223 

CHAPTER  XII. 

Examination  of  Anal,  Vaginal,  and  Uterine  Discharges 234 

CHAPTER  XIII. 

Examination  of  the  Integument  and  Muscles  for  Animal  and 

Vegetable  Parasites 252 

CHAPTER  XIV. 

Medico-Legal  Investigation  in   regard   to   Stains  'of  Blood, 

and  Spermatic  Fluid,  and  also  to  Poisons 282 

CHAPTER   XV. 

Hints  concerning  the  Examination  of  Morbid  Growths 305 


MEDICAL  MICROSCOPY. 


CHAPTER   I. 

THE    MICROSCOPE. 

As  a  full  exposition  of  the  optical  principles  upon  which 
achromatic  microscopes  are  constructed  would  require 
many  pages  of  description,  illustrated  by  numerous  draw- 
ings, I  must  content  myself  with  briefly  explaining  in 
regard  to  the  simple  microscope,  with  which  all  are  so 
familiar  in  the  form  of  a  pocket  magnifying-glass,  that  it 
depends  for  its  efficacy,  first,  upon  the  fact  that  objects 
appear  to  us  larger  or  smaller  in  proportion  to  the  dis- 
tance they  are  held  from  the  eye,  and  the  consequent  angle 
included  between  the  rays  of  light  given  off  from  their  ex- 
tremities ;  and,  second,  on  the  power  which  convex  lenses 
possess  (by  virtue  of  the  laws  of  refraction  of  light  on 
passing  from  a  rarer  to  a  denser  and  from  a  denser  to  a 
rarer  medium)  of  converging  the  pencils  of  rays  of  light 
emitted  from  every  part  of  an  object,  so  that  the  humors 
of  the  eye  can  bring  them  to  an  exact  focus  (upon  the 
retina)  when  that  object  is  held  much  nearer  to  the  eye 
than  is  otherwise  compatible  with  distinct  vision.  Thus, 
for  example,  an  inch  rule  held  at  the  distance  of  five 
inches  from  the  eye  will  appear  twice  as  long  as  one  held 
at  the  distance  of  ten  inches,  and  a  similar  rule  held  at 
the  distance  of  one  inch  will  seem  ten  times  as  long  as 

2  (9) 


10  MEDICAL  MICROSCOPY. 

that  at  ten  inches ;  but  its  parts  will  be  very  indistinct 
until  we  interpose  a  double  convex  lens  whose  focal 
length  is  one  inch,  through  which  its  details  will  all  be 
seen  clear  and  well  defined,  while  its  apparent  magnitude 
will  still  be  ten  times  that  of  the  inch  rule  held  at  ten 
inches.  Moreover,  not  only  are  the  individual  rays  of 
each  pencil  of  light  rendered  more  convergent,  but  the 
direction  of  the  pencil  itself  is  changed,  so  that  the  dif- 
ferent pencils  from  opposite  extremities  of  an  object  enter 
the  eye  at  a  greater  angle,  and  consequently  present  an 
image  larger  than  the  object  actually  is,  although,  prac- 
tically, this  does  not  seem  to  add  much  to  the  capacity  of  a 
lens  ;  for  opticians  having  arbitrarily  fixed  upon  ten  inches 
as  the  standard  of  distinct  vision,  a  lens  of  an  inch  focus, 
enabling  one  to  see  any  object  distinctly  at  the  distance 
of  about  an  inch,  is  stated  to  magnify  that  object  ten  times 
linear,  or  ten  diameters ;  while  a  lens  of  one-tenth  of  an  inch 
focus  magnifies  ten  times  ten,  or  one  hundred  diameters. 

The  simple  microscope — by  which  is  meant  one  com- 
posed of  a  single  lens — has,  however,  long  been  almost 
superseded  as  a  means  of  anatomical  and  medical  research 
by  the  compound  instrument,  consisting  of  single  lenses 
so  arranged  that  each  adds  to  the  power  of  the  other,  as- 
sociated with  suitable  mechanical  apparatus,  first,  for  ad- 
justing the  object  to  be  examined  at  a  proper  distance ; 
second,  for  enabling  the  observer  to  move  it  readily,  so  as 
to  bring  different  portions  into  view ;  and,  lastly,  for  con- 
centrating on  it  sufficient  light  to  render  it  clearly  visible. 
The  methods  of  obtaining  these  three  grand  desiderata 
vary,  of  course,  with  different  manufacturers,  some  one  of 
whom  personal  preference,  proximity  of  residence,  etc. 
will  render  most  eligible  to  the  purchaser  of  a  micro- 
scope,— so  that,  while  pointing  out  as  well  as  I  can  the 
peculiarities  and  advantages  of  each  particular  instru- 
ment, I  shall  earnestly  endeavor  to  do  so  without  preju- 


/•///•:  MICROSCOPE.  11 

dice,  in  a  thoroughly  impartial  manner,  and  solely  for  the 
benefit  of  my  readers,  seeking  to  make  no  attempt  at  re- 
commending any  particular  maker  above  his  fellow-crafts- 
men, and  fully  recognizing  the  fact  that  if  for  one  set  of 
purposes  the  productions  of  Messrs.  A,  B  &  C  are  best, 
for  another  they  may  be  greatly  surpassed  by  the  manu- 
facture of  Messrs.  X,  Y  &  Z.  Most  dealers  in  optical 
instruments  and  apparatus  furnish  catalogues  with  prices 
annexed,  which  can  be  obtained  on  application  by  letter 
or  personally,  as  directed  in  Appendix  A. 

Among  those  physicians  and  students  who  contemplate 
the  purchase  of  a  microscope  for  the  purpose  of  aiding 
them  in  the  practice  of  their  profession,  there  will,  of 
course,  be  some  to  whom  the  question  of  expense  is  of  but 
minor  consideration,  provided  they  obtain  a  satisfactory 
instrument ;  others,  again,  who  may  have  neither  leisure 
nor  inclination  for  anything  but  ordinary  office-work  in  the 
routine  of  practice,  would  consider  the  expenditure  of 
more  than  a  moderate  sum  injudicious,  in  view  of  the 
time  which  they  could  devote  to  the  subject;  while  others 
still  (and  among  them  many  of  the  energetic  young  men 
of  the  profession),  being,  in  the  outset  of  their  career, 
obliged  to  practice,  in  default  of  anything  else,  a  strict 
economy,  require  the  least  costly  instrument  which  will 
enable  them  to  solve  the  problems  of  microscopical 
diagnosis. 

Although  a  cheap  microscope  may  be  made,  by  supe- 
rior care  and  skill,  to  answer  the  purpose  of  more  valuable 
instruments  in  four  cases  out  of  five  where  its  assistance 
is  sought,  yet,  as  the  fifth  case  is  apt  to  be  the  one  of  all 
others  in  which  its  aid  is  most  necessary,  my  advice  is  to 
procure  a  good  instrument,  even  if  you  have  to  borrow  the 
purchase-money  for  a  year  or  two,  feeling  confident  that 
the  superior  accuracy  and  consequent  success  which  it 
must  insure  in  the  treatment  of  disease,  will  enable  you 


12 


MEDICAL   MICROSCOPY. 


FIG.  1. 


to  pay  more  than  a  liberal  interest  upon  the  loan,  and 
soon  to  discharge  the  entire  debt;  but  should  this  idea  of 
being,  even  for  a  time,  the  slave  of  a  creditor,  seem  too  re- 
pugnant, you  have  still  the  resource,  as  above  intimated, 
of  compensating  for  the  defects  of  an  inferior  instrument 
by  greater  patience  and  assiduity. 

The  figure  in  the  margin  represents  the  cheapest  really 
efficient  microscope  with  which  I  am  acquainted.     It  is 

called  Woodward's  Student's 
Microscope,was  first  arranged 
many  years  since  by  the  dis- 
tinguished Lieutenant-Colo- 
nel J.  J.  Woodward,  M.D.,  of 
the  Surgeon-General's  Office, 
Washington,  whilst  a  teacher 
of  microscopy  in  this  city, 
and  has,  I  am  informed,  been 
largely  sold  to  medical  men 
in  all  parts  of  the  United 
States  by  its  present  manu- 
facturers, Messrs.  J.W.  Queen 
&  Co  ,  No.  924  Chestnut,  St., 
Philadelphia.  The  cast-iron 
stand,  varnished  to  prevent 
rusting,  is  made  sufficiently 
heavy  to  avoid,  as  far  as  possible,  any  motion  of  the  in- 
strument from  the  vibration  of  surrounding  objects ;  the 
two  upright  standards  are  perforated  for  the  reception  of 
a  pivot,  upon  which  the  remainder  of  the  instrument  re- 
volves, in  order  to  adjust  it  at  any  angle  to  the  perpendic- 
ular most  convenient  for  the  observer ;  the  tube  or  "  body" 
of  the  instrument  slides  in  another  tube,  which  allows  of 
its  being  rapidly  raised  from  or  lowered  toward  the  stage, 
so  constituting  the  "coarse  adjustment,"  while  the  "fine 
adjustment,"  or  more  delicate  arrangement,  for  bringing 


Woodward's  Student's  Microscope. 


Tin-:  u/c/fowo /•/•:.  13 

tin-  l><>d  v  with  its  attached  lenses  nearer  to  or  farther  from 
the  object  under  examination,  is  obtained  by  turning  the 
screw-head  back  of  the  body,  seen  in  the  drawing  to  the 
riirht  of  the  center;  into  the  upper  end  of  the  body  slides 
the  "  eye-piece,"  a  combination  of  two  convex  lenses,  the 
upper  being  called  the  "eye-glass"  and  the  lower  the 
"  field-glass,"  whose  office  it  is  to  magnify  the  image 
formed  within  the  tube  by  the  "objective,"  as  the  associa- 
tion of  three  small  lenses  which  screws  on  to  the  lower 
end  of  the  body  is  called,  because  it  is  next  to  the  object 
undergoing  examination.  The  flat,  perforated  brass  plate 
situated  at  right  angles  to  the  body,  and  called  the 
"  stage,"  is  for  the  reception  of  a  glass  slide  carrying  the 
substance  to  be  investigated,  and  is  furnished  with  two 
"  spring  clips,"  beneath  which  the  slide  is  placed,  and  so 
held  securely  at  whatever  angle  the  instrument  may  be  in- 
clined Beneath  the  stage,  and  attached  to  it  by  a  pivot, 
on  which  it  revolves,  is  the  "diaphragm,"  a  circular 
metallic  plate,  perforated  with  holes  of  different  sizes, 
which,  by  turning  the  diaphragm,  can  each  be  brought 
successively  to  the  center  of  the  opening  in  the  stage,  so 
as  to  permit  a  greater  or  less  amount  of  light  to  pass  from 
the  mirror  below  to  the  object,  and  through  or  around  it 
to  the  objective  above.  The  mirror,  which  is  attached  to 
a  jointed  arm  beneath  the  stage,  is  suspended  in  a  movable 
semicircle  of  brass,  which  allows  of  its  adjustment  at  any 
angle,  in  order  to  permit  very  oblique  illumination  to  be 
employed  when  desired.  A  large  convex  lens,  called  a 
"condenser,"  is»furnished  in  addition,  attached  by  a  joint 
to  a  separate  stand,  so  as  to  enable  the  microscopist  to  ex- 
amine objects  by  direct  illumination — that  is,  by  concen- 
trating the  light  of  a  window,  for  example,  from  above 
upon  the  stage,  a  method  which  can  only  be  satisfactorily 
employed,  however,  with  the  lowest  power.  The  objec- 
tives supplied  with  this  instrument  are  of  French  manti- 

2* 


14  MEDICAL   MICROSCOPY. 

facture  (very  much  cheaper,  although  sometimes  nearly 
as  good  as  those  ordinarily  produced  by  English  or 
American  workmen)  ;  they  are  respectively  of  about  J 
inch  and  J  inch  focal  length,  the  latter  being  composed 
of  three  separate  achromatic  lenses,  which,  with  proper 
care,  can  be  safely  screwed  apart  and  cleaned  on  a 
soft  linen  rag  or  piece  of  buckskin.  The  first,  or  upper 
one  of  the  component  lenses  forming  the  |-  inch,  em- 
ployed alone,  but  assisted  by  the  eye-piece,  makes  an 
object  appear  100  times  as  long  as  it  really  is;  the  first 
and  second  together  magnify  about  250  diameters ;  and 
the  entire  combination  of  all  three  lenses  gives  a  magni- 
fying power  of  350  diameters  (vide  infra).  The  micro- 
scope and  accessories,  as  above  enumerated,  are  furnished 
complete,  and  packed  in  a  neat  mahogany  box,  for  $55.00. 

Mr.  W.  Y.  McAllister,  No.  728  Chestnut  Street,  Phila- 
delphia, furnishes,  among  others,  an  achromatic  microscope, 
13  inches  high,  with  a  brass  body,  to  incline  at  any  angle, 
micrometer  movement  for  focus,  movable  stage,  fitted  with 
one  eye-piece  and  one  set  of  achromatic  lenses,  giving 
powers  of  100,  200,  and  300  diameters,  for  the  extremely 
moderate  price  of  $42.00,  below  which  it  is  probably  use- 
less to  purchase  a  new  instrument  with  the  expectation  of 
its  satisfisfying  the  needs  of  a  practicing  physician. 

Messrs.  Queen  &  Co.  also  supply  an  achromatic  micro- 
scope, with  powers  ranging  from  50  to  650  diameters,  for 
$45.00. 

I  do  not  find  that  the  Messrs.  Grunow,  of  New  York, 
furnish  any  microscopes  so  low  priced  as  -those  above  de- 
scribed. These  gentlemen  quote  me  their  least  costly 
stand,  with  two  eye-pieces  and  condenser,  but  without 
any  objectives,  at  $50.00,  which,  as  the  J  inch  objective, 
giving  a  power  of  about  200  diameters,  is  set  down  at 
$35.00,  would  make  the  total  value  of  the  instrument  in 
working  order,  $85.00. 


TUK  MICROSCOPE,  15 

The  Boston  Optical  Works,  R.  B.  Tolles,  Superintendent, 
furnish  a  student's  microscope  (designed  under  the  advice 
of  several  of  the  professors  of  the  Medical  School  of  Har- 
vard College),  which  is  fifteen  inches  high  and  weighs  six 
pounds.  Its  base  and  uprights  of  cast-iron,  japanned,  to 
prevent  rust,  have  substantially  the  form  of  the  correspond- 
ing parts  of  Zentmayer's  Army  Microscope,  described  on  the 
next  page.  By  means  of  a  trunnion  joint  the  optical  portions 
of  the  instrument,  which  are  carried  by  the  curved  arm, 
can  be  placed  in  any  position  from  vertical  to  horizontal, 
a  stop  being  adjusted  so  as  to  prevent  movement  in  any 
direction  beyond  these  limits.  The  body  of  the  instrument, 
which  slides  in  a  tube  at  the  upper  end  of  the  arm,  is  fur- 
nished with  a  "  B"  eye-piece,  that  is,  an  eye-piece  which 
magnifies  nearly  one-third  more  than  the  lowest  (techni- 
cally called  the  most  shallow,  or  "  A")  eye-piece,  and 
two  second-quality  objectives,  of  1  inch  and  \  inch  focal 
length,  giving,  when  thus  combined  with  the  eye-piece, 
powers  respectively  of  about  60  and  280  diameters.  The 
stage  is  not  movable,  but  is  furnished  with  spring  clips, 
for  holding  a  slide  in  position,  beneath  which  the  slide 
bearing  the  object  is  to  be  moved  by  hand,  and  below  is 
placed  a  revolving  diaphragm,  also  a  concave  mirror,  fur- 
nished with  a  joint,  so  as  to  admit  of  the  employment  of 
oblique  light ;  for  direct  illumination  of  opaque  objects,  the 
mirror  is  removed  to  an  upright  stand.  The  coarse  adjust- 
ment for  the  focus  is  effected  by  sliding  the  compound 
body,  which  is  held  in  its  place  by  a  steel  spring,  while  a 
fine  adjusting  movement  is  obtained  by  a  new  method, 
said  to  be  eminently  efficient.  Mr.  Tolles  states  that  "the 
stand  is  made  with  all  the  care  bestowed  on  their  first- 
class  instruments,  and  proves  satisfactory  for  the  use  of 
amateur  students  and  the  ordinary  work  of  the  medical 
profession.  The  workmanship  is  superior  to  that  of  any 
instruments  of  the  class  made  in  Europe.  The  form  is  that 


16  MEDICAL  MICROSCOPY. 

best  adapted  for  easy  and  convenient  use."  Price,  in  an 
upright,  black  walnut  case,  $70.00.  (The  same  instrument, 
with  fine  adjustment  on  the  stage,  that  is,  arranged  so  that 
slight  changes  of  focus  are  effected  by  apparatus  for  moving 
the  stage  to  or  from  the  body  of  the  microscope,  instead  of 
vice  versa,  is  furnished  for  $50.00.) 

The  United  States  Army  Hospital  Microscope,  made  by 
Jos.  Zentmayer,  of  Philadelphia,  having  been  adopted  by 
the  authorities  at  our  seat  of  government  as  the  one,  among 
instruments  manufactured  in  this  country,  best  suited  on 
every  account  to  the  necessities  of  the  profession,  merits, 
of  course,  an  accurate  and  detailed  description,  and  may,  I 
believe,  be  at  any  time  purchased  either  of  the  maker  or  of 

his  agents,  J.  W,  Queen  &  Co., 
with  a  full  confidence  that  it 
will  suffice  for  all  the  ordinary 
wants  of  a  physician. 

This  excellent  instrument 
(Fig.  2)  is  supported  upon  a 
pillar  of  brass,  connected  with 
a  tripod  foot  of  the  same  metal, 
has  a  curved  arm,  which  car- 
ries the  body  (see  page  12), 
and  is  furnished  with  a  joint  by 
which  it  can  be  inclined  at  any 
angle  best  suited  to  the  eye  of 
the  observer.  The  coarse  adjust- 
ment is  obtained  by  a  toothed 
pinion,  working  upon  a  rack, 
by  means  of  a  double  milled 
head,  which  allows  of  motion 
being  communicated  by  either 
hand,  as  most  convenient,  while 

U.S.  Army  Hospital  Microscope.        tfae     fine    adjustment    IS    given 

by  a  micrometer  screw,  so  arranged  to  act  upon  the  end  of 
a  small  lever  as  to  cause  a  very  gradual  motion  of  the 


TITE  MlCROSCOn:.  17 

objective  to  or  from  the  object.  The  stage  consists  of  an 
oblong  piece  of  plate-glass,  moved  by  hand,  but  held  in 
any  required  position  by  the  pressure  of  a  spring,  whose 
tension  is  regulated  by  means  of  a  screw  which  passes 
through  its  extremity.  Beneath  the  stage  is  placed  a  tube, 
to  which  is  fitted  a  revolving  diaphragm,  with  holes  of 
varying  sizes,  for  allowing  of  different  degrees  of  illumina- 
tion. The  mirror  below  the  diaphragm  is  double,  one  side 
being  plain  and  the  other  concave,  and  mounted  so  as  to 
admit  of  the  employment  of  either  axial  or  oblique  illumi- 
nation. The  instrument  is  furnished  with  a  "deep"  and 
a  "  shallow"  eye-piece,  1  achromatic  objective  T85  of  an 
inch  in  focal  length,  giving,  with  the  shallow  eye-piece,  a 
power  of  about  50,  and,  with  the  deep,  one  of  nearly  100 
diameters,  and  another  objective  of  -J-  of  an  inch  focus  (not 
adjustable  for  the  varying  thickness  of  the  thin  glass  cov- 
ing the  object  examined),  giving,  with  the  eye-pieces 
respectively,  powers  of  about  250  and  450  diameters. 
It  is  also  supplied  with  a  camera  lucida,  for  drawing 
objects,  a  stage  micrometer,  with  division  lines  ruled  upon  it 
-j-J-jj-  and  -3-^5-5-  of  an  inch  apart,  and  a  condensing  lens  two 
inches  in  diameter,  upon  a  separate  stand ;  the  whole 
securely  packed  in  a  neat  walnut  box,  with  a  lock  and  key, 
for  $135.00. 

The  Messrs.  Grunow,  of  New  York,  advertise  to  furnish 
their  Student's  Microscope  Stand  (No.  1,  a)  for  eighty  dol- 
lars. The  instrument  is  on  a  tripod  base,  and  uprights, 
with  joint  to  incline  at  any  angle.  The  optical  body  has 
quick  and  very  delicate  fine  focusing  motions,  the  former 
working  by  two  milled  heads,  the  latter  by  a  fine  screw 
acting  upon  the  end  of  a  lever.  The  concave  reflector  is 
mounted  so  as  to  afford  oblique  as  well  as  axial  illumina- 
tion. The  stage  is  movable  in  rectangular  directions  by 
rack  and  screw,  and  its  upper  surface  is  formed  by  a  ground- 
glass  plate.  The  instrument,  as  quoted,  is  supplied  wish 
two  eye-pieces,  a  condenser  for  opaque  objects,  and  a 


18  MEDICAL   MICROSCOPY. 

case,  hut  requires,  in  addition,  a  1-inch  objective,  costing 
$18.00,  and  a  J-inch,  costing  $35.00,  so  that  its  entire  ex- 
pense, with  apparatus,  as  above  mentioned  (without  the 
camera  lucida  and  micrometer,  but  with  the  screw  move- 
ment for  the  stage),  amounts  to  $133.00. 

The  Boston  Optical  Works  will  manufacture  first-class 
A  and  B  Trunnion  Microscopes  by  special  contract.  An 
elegant  and  complete  instrument,  made  for  Robert  B. 
Howland,  Esq.,  President  of  the  Rowland  Institute  for 
Young  Ladies,  at  my  late  residence,  Union  Springs,  N.  Y., 
and  of  whose  very  superior  capacity  I  can  speak  from  fre- 
quent experience,  cost  $275.00 

Members  of  the  fortunate  class  on  which  the  res  angusta 
domi  does  not  press,  can,  of  course,  when  purchasing  a  mi- 
croscope, choose  their  instrument  of  almost  any  variety  of 
perfection  and  price,  up  to  Powell  &  Lealand's  No.  1,  Large 
Compound  Microscope,  with  Binocular  Arrangement,  cost- 
ing, complete,  £189,  or  near  $1800  in  this  country ;  yet  as 
few  such  purchasers  will  procure  instruments  without 
comparing  those  of  different  manufacturers,  not  only  per- 
sonally, but  with  the  aid  of  their  numerous  friends,  it  seems 
unnecessary  to  describe  here  many  different  master-pieces  of 
mechanism  all  so  perfect  as  to  make  the  selection  of  any 
one  a  difficult  problem.  As  a  representative  of  American 
workmanship,  Zentmayer's  Grand  Microscope  ranks  high, 
and  has  received  from  Dr.  F.  A.  P.  Barnard,  President  of 
Columbia  College,  N.  Y.,  as  Commissioner  of  the  United 
States  to  the  Exposition  Universelle,  Paris,  1867,  the 
flattering  encomium  that  "  nothing  could  be  more  tasteful 
or  elegant  than  the  first-class  stands  constructed  by  Zent- 
mayer."  This  excellent  instrument  stands  nineteen  inches 
high,  and  is  supported  upon  a  tripod  base,  whose  feet 
diverge  sufficiently  to  insure  complete  firmness  and  sta- 
bility. The  two  brass  pillars,  upon  which  the  body  and 
stage  are  swung,  rest  upon  a  revolving  plate,  with  a 
graduated  edge,  by  which  the  angular  aperture  of  the  ob- 


777 A' 


19 


jertives  may  be  ascertained.  The  body  is  moved  by  a 
double  milled  liesid.  pinion,  nnd  rack  for  the  coarse  arrange- 
ment, and  a  fine  micrometer  screw  for  the  delicate  adjust- 


Fia.  3. 


Zentmayer's  Grand  American  Microscope. 

rnent.  The  mechanical  stage  has  a  screw  adjustment, 
with  milled  head,  for  the  horizontal  motion,  and  a  delicate 
chain  and  pinion,  with  milled  head,  for  the  vertical  motion. 
On  the  center  of  the  upper  side  of  the  stage  a  circular 
plate,  with  a  graduated  edge,  is  attached  for  measuring 
angles  of  crystals.  The  whole  thickness  of  the  stage  is  but 
T3g  of  an  inch,  but  it  is,  nevertheless,  perfectly  solid  and 
steady,  and  affords  unusual  facility  for  great  obliquity  of 
illumination  when  difficult  tests  are  to  be  resolved.  Under 
the  stage  a  small  tube,  with  rack  and  pinion,  is  attached, 


20  MEDICAL  MICROSCOPY. 

in  which  the  accessory  illuminating  apparatus  is  carried 
when  in  use.  The  mirror  frame,  carrying  on  one  side  a 
plane,  and  on  the  other  a  concave  reflector,  is  mounted 
upon  a  jointed  bar  so  as  to  allow  of  any  required  adjust- 
ment for  oblique  illumination.  A  graduated  draw-tube, 
bearing  the  eye-pieces,  slides  in  the  main  body  of  the 
microscope,  for  increasing  the  magnifying  power  by  length- 
ening the  distance  between  the  objective  and  the  eye-piece. 
The  optical  portions  proper  of  the  instrument  consist  of 
three  eye-pieces,  A,  B,  and  C  ;  an  achromatic  objective  of  1 J 
inch  focal  length  and  22  degrees  angle  of  aperture  ;  one 
objective  -f$  of  an  inch  focus,  32  degrees  angle  of  aper- 
ture, one  of  y4^  of  an  inch  focus,  80  degrees  angle,  of  aper- 
ture, capable  of  adjustment  for  varying  thicknesses  of  thin 
glass  cover,  and  an  objective  of  ^  of  an  inch  focus,  also 
adjustable  for  the  thin  glass  cover  of  the  object;  the  highest 
power  thus  attainable  being,  with  the  -J-  objective  and  deep- 
est eye-piece,  without  using  the  draw-tube,  between  600 
and  100  diameters.  Of  accessory  apparatus,  this  micro- 
scope possesses  a  parabola  for  dark-field  illumination,  the 
rays  in  the  axis  of  the  instrument  being  cut  off  and  the 
substance  examined  being  viewed  as  an  opaque  object; 
an  erector  for  correcting  the  inversion  of  objects  produced 
by  the  ordinary  combination  of  lenses  in  microscopes,  and 
chiefly  used  in  making  dissections ;  a  polarizing  apparatus, 
with  selenite  plate,  for  subjecting  objects  to  the  test  of 
polarized  light ;  a  condensing  lens,  on  a  separate  stand,  for 
the  direct  illumination  of  opaque  objects  ;  a  camera  lucida, 
for  drawing  objects  as  magnified  under  the  microscope  ;  a 
stage  micrometer,  ruled  to  T-J-g-  and  y^1^  of  an  inch  ;  a  pair 
of  stage  forceps  for  holding  small  insects,  etc.,  during  ex- 
amination by  low  powers ;  an  animalcule  cage,  a  zoophyte 
trough  (a  glass  vessel  with  flat  sides,  for  the  more  con- 
venient examination  of  microscopic  animals  in  the  living 
state),  and  a  blue  glass  cap,  which,  fitting  beneath  the  stage, 
renders  the  light  much  less  trying  to  the  eye  of  the  observer ; 


7V/A'    M I  (' A'  ns<<(  >/'/•;.  21 

the  whole  packed  in  a  neat  walnut  box,  and  furnished  for 
$386.00. 

Supposing,  now,  that  a  microscope,  whether  one  of 
those  above  described  or  of  some  other  pattern,  has  been 
determined  upon,  how  are  the  objectives  to  be  selected, 
and  in  what  way  can  the  purchaser  convince  himself  that  he 
obtains  superior  lenses?  In  the  first  place,  I  would  ad- 
vise the  student  to  obtain  the  assistance  of  some  friend 
more  experienced  in  the  use  of  the  instrument  than  him- 
self in  testing  the  good  qualities  of  the  glasses  he  pro- 
poses to  buy,  assuring  him  that  all  the  printed  directions 
I  am  able  to  furnish  toward  that  end  will  not  be  sufficient 
to  enable  him  to  decide  this  important  question  nearly  as 
well  as  can  a  practiced  observer  who  has  had  opportunities 
of  working  frequently  with  the  objectives  of  different 
makers  and  carefully  testing  their  comparative  merits. 
Few  microscopists  would  be  apt  to  refuse  to  any  brother 
practitioner  of  our  liberal  art  so  small  a  favor,  and  I  may 
say  for  myself  that  I  shall  be  glad  to  assist  any  readers 
of  my  little  work  by  giving  them  my  own  opinion  (as 
heretofore  not  unfrequently  called  upon  to  do)  in  regard 
to  any  of  the  subjects  herein  attempted  to  be  elucidated ; 
nevertheless,  in  justice  to  the  opticians  above  mentioned, 
with  whom  I  have  had  more  or  less  extended  business 
transactions,  and  probably  others  personally  unknown  to 
me,  I  must  say  that,  although  slight  variations  in  the 
working  capacity  of  lenses  furnished  under  the  same 
name  do  happen,  there  is  little  question  that  any  one 
may  depend  upon  obtaining  glasses  of  good  quality, 
while,  should  any  accidental  error  occur,  it  will  be 
promptly  rectified  on  application.  Presuming,  how- 
ever, that  some  students  may  lack  such  opportunity  of 
consultation,  I  shall  detail,  as  clearly  as  I  can,  methods 
for  discovering  the  points  of  a  good  lens  under  the  head 
of  Manipulations,  in  the  next  chapter,  which  see. 

3 


22  MEDICAL    MICROSCOPY. 

Objectives  differ  in  magnifying  power,  in  defining 
power,  or  definition,  in  penetrating  power,  in  flatness  of 
field,  and  in  capacity  for  adjustment  for  variations  of 
media  through  which  the  object  is  examined. 

The  MAGNIFYING  POWER  of  an  objective,  according  to 
the  Linear  measurement,  which  is  that  commonly  adopted 
among  microscopists,  is  the  number  of  times  it  would  ap- 
parently enlarge  a  mathematical  line,  when  so  adjusted  as 
to  give  the  most  distinct  image  ;  thus,  for  example,  an 
objective  of  1  inch  focal  length,  as  ordinarily  manufac- 
tured, will  make  a  line  y1^  of  an  inch  long  appear  an 
inch  in  length.  This,  of  course,  is  when  used  alone  in 
the  manner  of  a  common  hand  magnifying-glass ;  when  it 
is  adapted  to  the  body  of  the  compound  microscope,  and 
the  image  it  forms  is  magnified  by  an  eye-piece  which 
amplifies  that  image  again  five  times,  we  obtain  an  in- 
crease of  the  apparent  magnitude  equal  to  fifty  times,  or 
fifty  diameters  linear  measurement ;  so  that,  for  instance, 
the  line  above  referred  to,  when  thus  viewed  through  the 
1  inch  objective  with  the  "A,"  or  most  shallow  eye-piece 
(no  use  being  made  of  a  draw-tube),  would  look  as  if  it 
were  five  inches  in  length.  It  will  be  seen  from  this  that, 
theoretically,  the  magnifying  power  of  a  lens  bears  a  defi- 
nite relation  to  its  focal  length  ;  but  practically  this  is  not 
precisely  the  case,  since  the  mechanical  difficulties  of  grind- 
ing and  fitting  the  component  lenses  produce  slight  varia- 
tions in  the  focal  distance,  and,  of  course,  in  the  power, 
— that  is,  a  lens  whose  focal  length  is  actually  1^  of  an 
inch,  and  its  magnifying  power  consequently,  when  ar- 
ranged with  an  eye-piece  as  above,  is  about  45  diameters, 
may  be  sold  as  an  inch  objective ;  or  the  error,  as  is  more 
frequently  the  case,  may  be  upon  the  other  side,  so  that  the 
purchaser  obtains  at  the  price  of  an  inch  objective  a  lens 
having  an  actual  power,  when  combined  as  described,  of 
55  diameters.  Such  variations  from  the  nominal  capacity 


Till-:  MICROSCOPE. 


23 


;iiv  unavoidable,  and,  provided  they  do  not  exceed  the 
limits  stated  above,  can  scarcely  be  objected  to.  One  of 
the  most  extensive  dealers  in  microscopes  in  this  country 
informed  me  that  their  rule  was  to  make  each  objective  to 
magnify  with  the  lowest  eye-piece  on  a  standard  stand, 
half  the  number  of  hundred  diameters,  signified  by  the 
denominator  of  the  fraction,  expressing  the  focal  length, 
e.g.  a  -£•  objective,  since  the  denominator  of  the  fraction  ex- 
pressing its  focal  length  when  divided  by  two  equals  2£, 
should  magnify  250  diameters.  As  will  be  seen  by  the 
accompanying  table,  Messrs.  Powell  &  Lealand,  the  cele- 
brated London  opticians,  estimate  the  magnifying  powers 
of  their  objectives  in  a  similar  manner. 

Achromatic  Object-glasses  for  Microscope. 


Magnifying  Power  with  the  various 

Object- 

i^hlSSt'S. 

Angular 

Apcrt  urtk. 

Eye-pieceg. 

Price. 

Liobor- 

kuiins. 

No.  1. 

2. 

3. 

4. 

5. 

2    in. 

14  degs. 

25 

37 

50 

100 

150 

£     *.* 

2  15 

St. 

10 

1*  " 

20 

37 

56 

74 

150 

220 

3     0 

10 

1 

30 

50       74 

100 

200 

300 

3     3 

8 

| 

32 

75 

111 

150 

300 

450 

3  10 

8 

70 

100 

148 

200 

400       600 

5     0 

6 

A 

80 

125 

187 

250 

500  !     750 

5     5 

6 

1 

95 

200  1   296 

400 

800  i  1200 

5     5 

5 

i 

130 

7     7 

1 

145 

8     8 

j 

100 

250 

370|    500 

1000 

1500 

6     6 

j 

140 

400 

592 

800 

1600 

2400 

8     8 

Tv 

145 

600 

888 

1200 

2400 

3600 

12  12 

A  " 

175 

800 

1184 

1600 

3200 

4800 

16  16 

&  u 

160 

1250 

1850 

2500 

5000 

7500 

21     0 

Js  " 

150 

2500 

3700 

5000 

10000 

15000 

31  10 

*  With  gold  at  120*,  and  the  duty,  as  at  present,  40  per  cent,  in 
specie,  the  pound  sterling  my  be  estimated  as  equal  here  to  nearly 
$10.00  in  currency. 


24  MEDICAL   MICROSCOPY. 

It  must  not  be  forgotten,  in  calculating  the  powers  of 
various  objectives  with  different  eye-pieces,  that  an  inch 
or  two  more  or  less  in  the  length  of  the  microscope  body 
makes  an  important  alteration  in  the  apparent  size  of  the 
object,  a  fact  which  is  taken  advantage  of  by  means  of  the 
draw-tube  to  enable  the  observer  to  increase  the  magnify- 
ing power  of  an  instrument  so  constructed.  The  focal 
length  of  an  achromatic  objective  is  by  no  means  the  dis- 
tance at  which  an  object  must  be  placed  from  the  surface 
of  the  front  combination, — the  latter  space  being,  on  an 
average,  less  than  half  the  former. 

DEFINITION  or  DEFINING  POWER  of  an  objective  is  that 
quality  which  enables  it  to  present  the  objects  it  magnifies 
with  clear,  sharp,  well-defined  edges,  as  if  engraved  upon 
the  field.  Excellence  in  this  respect  is  the  most  impor- 
tant attribute  of  a  first-class  objective,  and  constitutes  the 
great  point  of  difference  between  different  lenses  of  the 
same  focal  length. 

The  PENETRATING  POWER  of  an  objective  depends,  ac- 
cording to  the  editors  of  the  Micrographic  Dictionary, 
"  upon  two  distinct  circumstances — the  goodness  of  the 
defining  power  and  the  magnitude  of  the  angular  aperture 
of  the  object-glass.  The  degree  of  obliquity  of  the  light  is 
also  of  great  importance  in  connection  with  the  latter."  The 
term  "penetrating  power"  is  used  by  some  microscopists, 
more  correctly,  I  think,  as  having  reference  to  the  depth 
of  the  stratum  of  any  object  (measured  in  a  line  with  the 
axis  of  the  microscope)  which  is  in  focus  at  the  same  time. 

FLATNESS  OF  FIELD  of  an  objective  is  that  quality  which 
causes  every  part  of  an  object  lying  in  the  same  plane  to 
be  exactly  in  focus  when  its  central  portions  are  most 
distinct. 

Every  good  objective  must  be  free  from  chromatic  aber- 
ration, at  least  when  combined  with  the  lowest  eye-piece ; 
that  is,  brilliant  objects,  such  as  crystals,  must  be  pre- 


THE  MICROSCOri-.  25 

sented  with  their  outlines  sharp  and  black,  without  any 
iridescent  margins;  with  the  higher  eye-pieces,  which  so 
greatly  increase  the  imperfections  of  an  objective,  this 
fault  sometimes  occurs  even  in  lenses  of  superior  quality. 

The  objectives  manufactured  by  different  opticians  re- 
semble each  other  in  most  respects,  so  that  an  approxima- 
tive idea  of  their  numbers,  powers,  and  prices  may  be 
gathered  from  the  table  on  page  23,  taken  from  the  cata- 
logue of  Messrs.  Powell  &  Lealand.  Each  higher  objec- 
tive is  composed  of  three  pairs  of  lenses,  the  glasses  of 
every  pair  or  doublet  being  so  combined  with  each  other 
as  to  neutralize  their  respective  errors  of  spherical  and 
chromatic  aberration.  In  objectives  of  more  than  J  of  an 
inch  focal  length,  these  doublets  are  each  cemented  at 
suitable  distances  from  the  others  in  the  brass  tubes  which 
contain  them;  but  in  the  higher  objectives,  provision  is 
generally  made  for  altering  the  distances  between  the 
front  (anterior,  or  outside)  combination  and  the  other  two 
by  means  of  a  screw  collar,  graduated  into  degrees,  upon 
its  external  surface  ;  a  lens  so  arranged  is  said  to  be  "  ad- 
justable to  the  thickness  of  the  thin  glass  cover,"  and  pos- 
sesses the  great  advantage,  that  covers  of  different  thickness 
can  be  employed  without  interfering  with  the  defining 
power. 

Immersion  lenses  were  primarily  suggested  by  Amici, 
but  the  idea  appears  to  have  been  first  rendered  practi- 
cally useful  by  M.  Nartnack,  a  distinguished  optical  in- 
strument-maker of  Paris ;  they  are  now  made  by  most 
of  the  prominent  opticians  in  this  country  and  Europe. 
The  name  immersion  is  applied  to  them  because  the  con- 
stituent doublets  are  so  arranged  that  the  first  combination 
must  be  immersed  in  distilled  water,  a  drop  of  which  is  to 
be  placed  upon  the  covering  glass  of  the  object  before  the 
body  of  the  instrument  is  screwed  down,  so  that  anything 
upon  the  slide  is  viewed  through  a  stratum  of  water  in- 


26  MEDICAL   MICROSCOPY. 

stead  of  one  of  air,  as  is  the  case  when  ordinary  or  "  dry" 
objectives  are  employed.  The  advantages  claimed  for 
immersion  lenses  are  that  the  object  is  more  highly  illu- 
minated, because  more  oblique  rays  are  admitted  than 
would  otherwise  be  refracted  so  as  to  pass  through  the 
lens,  and  the  "  working  distance"  (or  space  between  the 
front  combination  and  the  thin  glass  cover)  is  increased 
— both  of  which  I  have  found  these  lenses  to  possess  in  a 
high  degree. 

From  what  has  been  stated  above,  it  will  be  readily  un- 
derstood that  objectives  of  the  lower  powers  are  manufac- 
tured by  various  opticians  with  almost  equal  success,  so 
that,  with  lenses  of  J  inch  focus  or  more,  it  is  often  a 
matter  of  extreme  difficulty  and  delicacy  to  choose  be- 
tween them,  while,  should  they  differ  to  any  great  extent 
in  excellence,  microscopists  may  be  found  in  almost  every 
locality  who  have  practical  experience  enough  to  point  out 
their  faults.  In  regard  to  the  higher  powers,  however, 
it  is  much  more  difficult  to  form  a  correct  estimate,  as 
few  standards  of  comparison  are  attainable ;  and,  by  way 
of  furnishing  some  contribution  to  the  literature  of  the 
subject,  it  may  not  be  out  of  place  to  detail  briefly  my 
own  personal  experience. 

I  had  an  opportunity,  not  long  since,  of  examining  and 
working  for  a  short  time  with  an  Immersion  •£$,  made  by 
Mr.  Tolles,  of  the  Boston  Optical  Works,  which  performed 
better  than  any  objective  of  its  focal  length  that  I  had 
previously  seen.  When  accurately  focused,  the  space  be- 
tween the  end  of  the  lens  and  the  upper  surface  of  the 
cover  (working  distance),  although  small,  was  ample, 
being  nearly  twice  that  of  the  -fa-  the  magnifying  power 
was  fully  equal  to  the  standard  (500  diameters)  ;  the  defi- 
nition very  superior;  the  penetrating  power,  as  tested 
upon  a  light  Podura  scale,  very  good ;  its  field  perfectly 
flat,  and  the  image  formed  by  it  entirely  free  from  chro- 


THE  MTCROSCOPE.  27 

mat  it-  aberration.  It  was  mounted  for  use,  either  Dry  or 
Immersed,  and  when  employed  in  the  latter  condition  de- 
fined well  with  deeper  eye-piecing  than  any  lens  I  ever 
saw  before,  showing,  upon  my  Powell  <fc  Lealand's  stand, 
with  their  No.  4  Eye-piece,  the  limiting  membrane  and  re- 
volving molecules  of  the  salivary  corpuscles  with  remark- 
able clearness.  The  price  of  such  a  glass  of  160°  angle 
of  aperture  is  $85.00. 

A  large  part  of  my  microscopic  work  during  the  past 
two  years  has  been  done  with  a  3^  inch  objective,  made 
by  Mr.  Wm.  Wales,  of  Fort  Lee,  N.  J.,  and  arranged 
for  use  either  as  a  Dry  or  Immersion  lens;  its  defin- 
ing and  penetrating  powers  are  excellent,  its  field  entirely 
flat,  and  when  "immersed"  its  magnifying  power  is  fully 
what  it  should  be,  as  it  amplifies  rather  more  than  1250 
diameters,  although  when  used  dry,  the  enlargement 
of  an  object  viewed  through  it  when  most  accurately  ad- 
justed is  not  quite  so  great.  Its  working  distance  is  very 
good,  allowing  the  employment  of  a  glass  cover  -,-^-5-  of 
an  inch  thick,  and  therefore  not  so  delicate  but  that  it  can 
be  readily  cleansed  in  the  ordinary  way  between  folds  of 
soft  linen.  The  adjustments  for  thickness  of  the  covering 
glass,  and  for  changing  it  from  a  "  wet"  to  a  "dry"  lens, 
are  made  by  the  revolution  of  the  same  screw-collar, 
divided  into  ten  degrees,  and  so  arranged  that,  if  placed 
at  2°,  it  gives  the  best  definition  of  an  uncovered  object; 
at  5°  the  best  when  used  dry  with  a  cover  of  the  thick- 
ness mentioned  above ;  and  at  8°  the  best  when  used  as 
an  immersion  lens.  I  have  found  the  stage  of  Powell  & 
Lealand's  stand  steady  enough,  and  supplied  with  hori- 
zontal and  vertical  movements  quite  sufficiently  in  the 
same  plane  to  allow  of  its  satisfactory  use ;  and  with  the 
achromatic  condenser  belonging  to  my  instrument,  I  can 
obtain  plenty  of  light,  even  when  the  No.  4  eye-piece  is 
used.  When  I  first  obtained  this  glass, — having  never 


28  MEDICAL   MICROSCOPY. 

worked  with  anything  above  J,  —  I  was  much  disap- 
pointed that  it  did  not  enable  me  to  see  more ;  but  after  a 
short  time  I  found  that  the  great  trouble  was  insufficiency 
of  light,  and  on  illuminating  the  field  of  my  microscope 
much  more  highly,  I  beheld  for  the  first  time,  to  my  great 
delight,  the  movement  of  the  molecules  in  the  salivary 
corpuscles,  which,  although  often  sought  for,  had  always 
before  escaped  my  observation.  The  cost  of  this  lens  was 
$120.00. 

Within  the  last  few  months  I  have  procured  from 
Messrs.  Powell  &  Lealand,  of  London,  a  -fa  inch  Dry  ob- 
jective, warranted  to  be  equal  to  the  one  of  which  Prof. 
Beale  speaks  so  highly  in  his  volume  on  "  How  to  Work 
with  the  Microscope."  Its  penetrating  power  and  its  defi- 
nition, as  tested  upon  the  Podura  scale  and  the  salivary 
corpuscles,  are  excellent ;  its  field  is  perfectly  flat,  and  its 
magnifying  power,  like  that  of  Dr.  Beale's,  is  superior  to 
the  nominal  capacity,  somewhat  exceeding  2800  diameters 
with  the  lowest  eye-piece.  (See  Fig.  28.)  Its  working 
distance  is,  of  course,  very  small,  even  with  the  extremely 
thin  glass  covers  imported  with  it  for  the  purpose,  and 
which  are  so  very  delicate  that  they  can  only  be  cleansed 
between  two  flat  surfaces  and  require  the  greatest  care  in 
handling.  In  regard  to  illumination,  I  find  no  difficulty  in 
obtaining  sufficient  light  for  its  use  with  the  No.  1  and 
No.  2  eye-pieces,  by  bringing  an  Argand  gas-burner  close 
to  the  mirror  and  screwing  up  the  achromatic  condenser 
until  nearly  in  contact  with  the  under  surface  of  the  slide, 
but  with  the  third  and  fourth  eye-pieces  the  field  is  too 
dim  to  be  satisfactory.  The  fine  adjustment  for  altering 
the  focus  and  the  stage  movement  work  smoothly  enough 
to  answer  the  purpose,  and  the  stand  is  sufficiently  steady 
to  avoid  any  inconvenient  vibration.  The  price  of  such  a 
lens,  as  will  be  seen  by  the  table  on  page  23,  will  be  about 
$300.00,  and  mine  was  safely  brought  to  me  by  the 


77/77  MICROSCOrt-:.  t>«.) 

Ainrrico-European  Kxpress  from  London  at  a  very  sin;ill 
additional  cost.  As  far  as  I  can  learn,  there  are  at  pres- 
ent but  two  other  objectives  of  this  focal  length  in 
America — one  in  the  Army  Medical  Museum  at  Washing- 
ton and  the  other  in  the  possession  of  Dr.  Atkinson,  of 
New  York  city,  the  latter,  I  was  informed  some  time 
ago,  not  then  in  good  working  order. 

Much  has  been  said  against  the  advantages  of  using 
these  high  powers,  and  their  opponents,  as  for  example 
a  writer  not  long  since  in  the  Quarterly  Journal  of  Micro- 
scopical Science,  have  even  maintained  that,  notwithstand- 
ing their  frequent  employment,  we  have  yet  to  hear  of  any 
important  discovery  made  by  their  assistance.  Neverthe- 
less, my  own  opinion  is  most  unequivocally  in  their  favor, 
and  it  seems  to  me  that  the  detection  of  moving  molecules 
in  distended  white  blood  corpuscles*  of  the  cell-walls  of 
the  red  blood  disks  in  fragments  of  dried  clot,f  and  of  Hal- 
ford's  "  peculiar  cells"  in  the  blood  of  animals  poisoned 
by  serpents'  venom, J  after  they  had  escaped  the  attention 
of  such  skillful  and  acute  observers  as  Professors  Yir- 
chow,  Wyman,  and  Fayrer  respectively,  can,  of  course, 
only  be  due  to  the  superiority  of  the  lenses  I  have  em- 
ployed. 

Among  the  essential  portions  of  the  microscope  it  now 
only  remains  for  me  to  describe  the  eye-pieces,  whose 
superior  excellence,  valuable  as  it  is,  is  much  less  impor- 
tant than  that  of  the  objectives,  because  the  faults  of  the 
former  are  seen  only  as  they  really  are,  while  those  of  the 
latter  are  exaggerated  in  exact  proportion  to  the  power  of 
the  eye-pieces  employed  with  them.  Most  eye-pieces  are 
composed  of  two  achromatic  lenses, — the  upper,  or  that 

*  Penna.  Hospital  Reports,  18G9,  p.  249. 
f  Am.  Jour,  of  Mod.  Sciences,  July,  1869. 
J  Ibid.,  April,  1870. 


30  MEDICAL   MICROSCOPY. 

nearer  to  the  eye  being  called  the  eye-glass,  and  the  lower, 
nearer  to  the  field  of  the  instrument,  being  therefore  called 
the  field -glass;  these  different  combinations  of  lenses 
of  varying  convexity,  and  consequently  of  varying  mag- 
nifying power,  have  received  the  names  of  the  No.  1, 
No.  2,  etc.,  but  are  sometimes  spoken  of  by  continental 
opticians  as  the  A,  B,  C,  etc.  eye-piece.  The  tyro  may 
readily  recognize  them  by  remembering  that  their  power 
is  generally  inversely  as  their  length  ;  that  is,  the  strong- 
est (technically  called  deepest),  No.  5,  or  E  eye-piece,  is 
the  shortest  of  all,  while  the  weak  A,  or  No.  1,  called  by 
opticians  the  most  shallow,  is  nearly  twice  as  long  as  any 
of  the  rest.  The  micrometer  eye-piece,  in  its  simplest 
form,  consists  of  an  ordinary  (Huyghenian)  combination, 
into  whose  brass  mounting  tube  opposing  slits  are  cut,  so 
that  a  slip  of  glass,  upon  which  is  ruled  a" graduated  scale 
of  fiftieths  or  hundredths  of  an  inch,  may  be  passed  in,  thus 
enabling  the  observer  to  measure  the  size  of  objects  seen 
through  the  slip  of  glass,  the  value  of  each  division  with 
any  particular  objective,  and  length  of  microscope  body 
being  first  ascertained  as  described  in  the  next  chapter. 
The  cobweb  micrometer  consists  of  a  flat,  oblong  brass 
box,  arranged  permanently  between  the  eye-glass  and 
field-glass  of  an  eye-piece  (just  as  the  glass  micrometer  is 
temporarily  slipped  into  the  simpler  form),  and  containing 
a  light  brass  frame  just  fitting  the  width  of  the  box,  and 
capable  of  being  moved  very  gradually  backward  and 
forward  by  the  action  of  a  screw  which  works  through 
one  of  its  ends ;  across  this  frame,  and  of  course  moving 
with  it,  is  stretched  a  delicate  thread  of  spider's  web, 
while  across,  from  side  to  side  of  the  box,  is  another 
and  parallel  thread,  of  course  immovable.  To  measure  any 
minute  object  in  the  field  of  view,  the  stationary  thread, 
the  movable  thread,  and  the  left  hand  margin  of  the  object 
are  brought  exactly  in  line  by  turning  the  micrometer  screw 


THE  MICROSCOPE.  31 

and  by  adjustment  of  the  slide  upon  the  stage  of  the 
microscope,  and  then,  by  further  revolution  of  the  microm- 
eter screw,  the  movable  thread  is  slid.along  to  the  right 
until  it  just  touches  the  right  hand  edge  of  the  object, 
whiMi  the  number  of  whole  turns  is  read  off  by  means  of 
notches  within  the  box,  and  the  number  of  hundredths  of 
a  turn  by  the  divisions  upon  the  graduated  silver  circle 
attached  to  the  screw-head,  the  value  of  which  divisions 
having  been  previously  ascertained  for  each  objective,  a 
simple  calculation  enables  one  to  obtain  the  diameter  of 
the  object  desired.  In  Ramsden's,  or  the  positive  eye-piece, 
sometimes  used  as  a  micrometer  eye-piece,  the  field-glass 
is  placed  with  its  convex  side  upward,  instead  of  the  re- 
verse, and  so  much  nearer  the  eye-glass  that  the  image  is 
formed  beneath  it  in  place  of  between  the  two  lenses  ;  its 
disadvantage  is  want  of  flatness  of  field.  Kellner's  Or- 
thoscopic  Achromatic  Eye-piece,  according  to  Carpenter 
on  the  Microscope  (4th  edition,  London,  1868,  p.  26),  is  so 
constructed  that  "  the  field-glass,  which  is  a  double  con- 
vex lens,  is  placed  in  the  focus  of  the  eye-glass  without 
the  interposition  of  a  diaphragm,  and  the  eye-glass  is  an 
achromatic  combination  of  a  plain  concave  of  flint,  with  a 
double  convex  of  crown,  which  is  slightly  under-corrected, 
so  as  to  neutralize  the  over- correction  given  to  the  objec- 
tives that  are  ordinarily  used  with  the  Huyghenian  eye- 
pieces." It  gives  a  large,  flat,  well-illuminated  field,  but 
somewhat  impairs  the  defining  power.  In  default  of  a 
variety  of  eye-pieces,  the  student  may  nearly  double  the 
power  of  the  one  he  has  by  screwing  off  the  field-glass 
and  using  the  eye-glass  alone,  or  by  adapting  a  roll  of 
pasteboard  to  the  body  of  his  microscope,  in  the  manner 
of  a  draw-tube,  so  as  to  lengthen  the  distance  between  the 
eye-piece  and  objective. 

The  adaptation  of  Prof.  Wheatstone's  invention  of  the 
stereoscope  to  the  microscope,  in  the  form  of  the  binoc- 


32  MEDICAL   MICROSCOPY. 

ular,  has  enabled  us,  by  the  combination  of  two  dissimilar 
images  of  an  object  simultaneously  impressed  upon  the 
two  retinae,  to  obtain  that  accurate  perception  of  solidity 
which  observation  with  a  single  eye  fails  to  give.  In  this 
instrument,  by  means  of  an  arrangement  of  prisms  placed 
just  above  the  objective,  that  combination  is,  as  it  were, 
bisected,  and  two  images  formed  on  the  two  opposite  sides 
of  the  lens  are  refracted  upward  through  separate  tubes, 
one  to  each  eye  respectively ;  when  the  pencils  of  rays 
which  form  these  images  are  crossed,  so  as  to  reach  the 
eye  on  the  opposite  side  from  that  whence  they  proceed, 
the  picture  formed  by  them  is  in  relief,  or  stereoscopic, 
while,  if  allowed  to  enter  the  eyes  without  this  decussa- 
tion,  so  to  speak  (and,  by-the-way,  may  this  not  give 
some  clue  to  the  design  of  the  decussation  of  the  pyra- 
mids and  of  the  optic  nerves  ?),  the  picture  appears  exca- 
vated, or,  as  it  is  called,  pseudoscopic.  This  improvement 
can  be  adapted  to  first-class  microscopes  of  the  ordinary 
form,  at  an  expense  of  about  $100.00,  by  most  of  the  lead- 
ing opticians ;  and  Messrs.  J.  W.  Queen  &  Co.  have  re- 
cently imported  a  Student's  Binocular,  made  by  Collins,  of 
London,  which  they  furnish  complete  at  about  $50.00. 


CHAPTER   II. 

INSTRUMENTS,   APPARATUS,   AND    MANIPULATIONS. 

THE  ingenuity  of  microscope-makers  has  led  to  the  inven- 
tion of  an  almost  infinite  variety  of  additional  apparatus  for 
the  purpose  of  saving  labor,  time,  and  trouble,  at  the  cost,  of 
course,  of  increased  pecuniary  outlay;  but  as  the  microsco- 
pist  who  makes  the  study  enough  of  a  specialty  to  render  it 
worth  while  for  him  to  procure  these  luxuries,  will  doubtless 
obtain  also  much  more  pretentious  and  elaborate  treatises 
upon  the  subject  than  mine,  I  shall  but  briefly  allude  to 
the  high-priced  accessories,  and  describe  in  detail  only 
those  few  which  are  indispensable  and  those  which  can 
be  arranged  by  an  operator  himself  at  a  trifling  cost ;  as- 
suring the  student  that  the  trouble  thus  expended  in  ad- 
justing home-made  apparatus  to  the  instrument  will  be 
amply  repaid  by  the  greater  familiarity  with  the  practical 
working  of  the  microscope  which  he  will  thus  attain. 

Among  materials  of  primary  importance,  are  to  be  pro- 
cured glass  slides  for  the  examination  and  mounting  of 
objects;  these  should  be  of  plate  glass,  as  free  as  possible 
from  stains  or  scratches,  and  cut  to  the  exuct  standard 
size  of  three  inches  long  by  an  inch  wide,  in  order  to  n't 
into  cabinets  and  object-holders.  They  may  be  obtained 
of  dealers  in  Philadelphia,  and  I  suppose  elsewhere,  at  60 
cents  per  dozen  for  those  with  ground  edges,  and  25  cents 
per  dozen  for  those  whose  edges  are  unground,  the  only 
disadvantage  of  the  latter  being  an  occasional  cut  from 
careless  handling.  Until  the  student  commences  to  mount 

4  (33) 


34  MEDICAL  MICROSCOPY. 

specimens  for  permanent  preservation,  one  dozen  will  be 
quite  enough  for  him  to  purchase  ;  indeed,  he  may  save 
himself  some  mortifying  blunders  by -using  but  a  single 
slide  while  it  lasts,  and  so  becoming  familiar  with  all  its 
microscopic  flaws  and  scratches,  which  I  have  known  to 
*be  mistaken  for  epithelial  cells,  fibrin  filaments,  and  other 
important  abnormal  ingredients  of  urine,  blood,  sputum, 
milk,  pus,  etc. 

Thin  glass  covers  for  placing  over  the  object  as  dis- 
played upon  the  slide  are,  of  course,  absolutely  necessary, 
and  maybe  procured  in  the  form  of  either  circles  or  squares, 
the  former  costing  forty  and  the  latter  thirty  cents  per 
dozen.  For  ordinary  examinations  merely,  the  squares 
answer  every  purpose  ;  but  for  mounting,  the  circles  are 
more  convenient,  and  present  a  much  neater  appearance 
as  finished.  When  soiled,  the  covers  are  best  cleaned  by 
dipping  them  in  water  and  then  holding  them  by  the  op- 
posite edges  between  the  left  finger  and  thumb,  while 
they  are  carefully  but  firmly  rubbed  dry  and  bright  with 
a  soft  linen  or  muslin  cloth  (not  so  old  as  to  shed  lint), 
spread  over  the  corresponding  digits  of  the  right  hand. 
For  cleaning  the  very  thin  glass  required  for  covering  ob- 
jects examined  with  the  ^V  an^  -£$,  I  have  generally 
found  it  sufficient  to  lay  a  soft  rag  upon  the  table,  place 
the  cover,  after  dipping  in  water,  upon  it,  and  then,  folding 
the  cloth  over,  rub  the  glass  gently  between  the  two 
layers  of  muslin,  turning  it  if  necessary,  until  cleansed; 
or  the  method  advised  by  Prof.  Beale,  of  preparing  two 
flat  disks  of  wood,  covered  with  buckskin,  and  polishing 
the  thin  glass  between  them,  may  be  adopted.  I  have 
obtained  glass  thin  enough  for  use  with  the  J-  inch  ob- 
jective from  the  Messrs.  Grunow,  of  New  York,  but  for  my 
^,  was  obliged  to  import  some  of  exceeding  tenuity  from 
Powell  &  Lealand,  of  London.  My  experience  with  thin 
Iamina3  of  mica,  recommended  by  some  authorities,  has  not 


iirsTiir.vi-:\rs,  APPARATUS,  ETC.  35 

been  very  satisfactory,  for,  besides  the  tendency  of  this  sub- 
stitute to  become  scratched  very  soon,  I  have  not  found  the 
definition  of  objects  seen  through  it  equal  to  that  obtained 
when  glass  was  employed.  With  low  powers  of  the 
microscope,  that  is,  objectives  of  more  than  J  of  an  inch 
focus,  moderate  differences  in  the  thickness  of  the  glass 
covers  are  unimportant  and  may  be  quite  ignored,  but 
with  the  higher  powers,  delicate  adjustment  is  necessary 
in  accordance  with  the  thickness  of  the  covering  lamina, 
as  will  be  described  under  the  head  of  Manipulations. 

Small  needles,  mounted  in  light  wooden  handles,  are 
required  in  arranging  the  tissues  of  morbid  growths,  etc. 
for  examination  with  the  microscope;  they  are  readily 
prepared  by  making  a  wooden  cylinder,  about  the  size  of  a 
small  lead-pencil,  forcing  the  point  of  a  No.  6  needle,  held 
with  a  pair  of  pincers,  into  the  end,  so  as  to  make  a  punc- 
ture about  half  an  inch  deep  in  the  axis  of  the  stick,  and 
then  reversing  the  needle,  imbedding  its  eye  to  about 
the  same  depth  in  this  aperture.  These  little  instru- 
ments are  invaluable  in  " teasing"  out  small  fragments  of 
healthy  structure  or  of  morbid  growths,  as  described  in 
Chapter  XV. 

Forceps  and  scalpels  for  dissecting  off  minute  fragments 
of  tissues  for  microscopic  examination  may  be  such  as 
almost  every  medical  man  possesses  in  his  pocket-  and  dis- 
secting-case,  and,  therefore,  require  no  special  description. 
Very  satisfactory  thin  sections  can  often  be  cut  with  a 
sharp  razor. 

Conical  glasses  of  about  five  ounces  capacity  are  very 
useful  in  examinations  of  urinary  deposits.  They  should  be 
selected  with  a  cavity,  rounded  at  the  apex  of  the  cone, 
and  not  tapering  to  a  point,  because  then  they  are  very 
difficult  to  keep  clean  and  so  lead  to  lamentable  errors. 
Comparative  observations  on  the  bulk  of  sediments  are 
much  facilitated  by  having  these  vessels  graduated,  as 


36  MEDICAL   MICROSCOPY. 

can  readily  be  done  by  desiring  a  druggist  to  measure 
into  them  one,  two,  four,  and  eight  fluidrachms,  and  four 
fluidounces  of  water,  marking  the  level  of  the  liquid, 
after  each  portion  is  poured  in,  with  a  file  upon  the 
glass. 

Tube  pipettes  should  be  made  by  the  operator  himself 
by  drawing  off  to  a  point,  in  the  flame  of  an  alcohol  lamp 
or  gas-burner,  pieces  of  glass  tube  12  inches  long  and 
about  T3g  of  an  inch  in  external  diameter,  and  then  break- 
ing off  the  tips  so  as  to  leave  apertures  large  enough  to 
admit  a  pin.  For  ordinary  use  the  instrument-makers' 
pipettes  with  bulbs  blown  upon  their  stems  have  no  ad- 
vantage, and  are  much  more  fragile  and  expensive  than 
those  just  recommended.  Small  glass  tubes  of  the  kind 
referred  to  may  be  cut  to  any  length  by  making  a  little 
notch  in  one  side  with  a  file  (as  that  on  the  nail-blade  of  a 
common  pocket-knife),  and  then  sharply  bending  the  tube 
away  from  the  notch,  at  the  same  time  pulling  the  two  ends 
strongly  apart ;  in  this  way  an  exact  transverse  fracture 
may  generally  be  secured  ;  but  if  projections  remain  which 
would  interfere  with  the  complete  closure  of  the  pipette 
by  the  finger,  they  may  be  removed  by  light  rasping 
touches  of  the  flat  surface  of  the  file.  Any  unpracticed 
person  will  be  surprised,  on  trial,  at  the  ease  with  which 
glass  tubing  may  be  manipulated  as  above  described. 

Among  the  few  reagents  that  are  necessary,  acetic  acid 
is  one  of  the  most  important,  since  its  effect  upon  organic 
cells,  in  rendering  the  nucleus  more  distinct,  is  often  of 
great  value ;  it  should  be  of  the  strength  denominated  by 
apothecaries  No.  8  (because  when  mixed  with  seven  times 
its  bulk  of  water  it  corresponds  to  vinegar  in  acidity),  and 
is  best  kept  in  a  test-bottle  with  an  elongated  conical 
stopper,  or,  what  answers  the  same  purpose,  in  a  vial 
having  inserted  in  the  lower  part  of  its  cork  a  short  piece 
of  glass  rod  (or  of  glass  tube  drawn  off  to  a  point  and 


INSTRUMENTS,  APPARATUS,  ETC.  37 

sealed),   by  which    a   drop   of   the   reagent   can   at   any 
moment  be  applied  where  required. 

Aqueous  solution  of  iodine  is  sometimes  very  useful 
in  rendering  delicate  cell  membranes,  the  tube-casts  of 
Bright's  disease,  etc.  more  distinct  under  the  microscope. 
A  convenient  preparation  is  made  by  adding  ten  drops 
of  the  Liquor  lodinii  Comp.,  U.  S.  P.,  to  a  fluidounce  of 
water,  but  occasionally  a  mixture  of  three  or  four  times 
that  strength  will  be  found  useful. 

Solution  of  aniline  red  gives  a  beautiful  purple  tint  to 
most  organic  cells,  and  especially  their  nuclear  or  "ger- 
minal" matter.  It  should  be  prepared  by  dissolving  one 
grain  of  the  greenish  "  Fuchsine  dye"  in  an  ounce  of  water. 
The  solution  of  this  substance  may  be  greatly  accelerated 
by  the  addition  of  acetic  acid ;  but,  as  for  some  purposes 
a  neutral  reagent  is  advantageous,  I  prefer  to  dissolve  it 
by  mere  agitation. 

A  preparation  I  have  found  very  useful  is  a  simple  or 
carbolated  syrup,  of  the  specific  gravity  of  blood  serum 
(1028),  made  by  dissolving  about  40  grains  of  sugar  in 
an  ounce  of  water,  and  prevented  from  undergoing  de- 
composition by  adding  five  drops  of  crystallizable  carbolic 
acid ;  in  this  liquid  cancer  cells,  blood  corpuscles,  etc.  re- 
tain their  shape  and  general  appearance  almost  as  if  ex- 
amined in  the  fluids  of  the  body  which  normally  bathe 
them,  and  therefore,  of  course,  much  more  correct  views 
of  their  nature  may  be  obtained.  A  dilute  glycerin  of 
similar  specific  gravity,  made  by  mixing  three  and  a  half 
fluidrachms  of  "Bower's"  glycerin  with  four  ounces  of 
water,  is  preferable,  as  being  free  from  any  tendency  to 
decomposition. 

For  chemical  processes  intimately  associated  with 
microscopical  research,  the  student  will  require  half  a 
dozen  test-tubes  with  their  rack,  an  alcohol  lamp,  and  the 
usual  reagents, — among  which  are  nitric  acid,  for  detecting 

4* 


38  MEDICAL   MICROSCOPY. 

albumen ;  solutions  of  sulphate  of  copper  and  of  caustic 
potash  (or  Barreswil's  test*),  for  examining  urine  when, 
from  any  cause,  as  the  presence  of  torula  in  abundance, 
the  existence  of  sugar  from  diabetes  is  suspected;  also 
blue  and  red  litmus-papers,  for  testing  the  reaction  of  urine, 
vomit,  etc.  He.  should  likewise  be  provided  with  a  small 
capsule  or  evaporating  dish  of  about  two  ounces  capacity, 
and  a  supply  of  solution  of  caustic  soda,  made  with  five 
drachms  of  the  caustic  alkali  of  the  shops  to  one  pint  of 
pure  water,  for  the  purpose  of  testing  sputum,  as  directed 
in  Chapter  IX.  A  urinometer  and  accompanying  jar  for 
testing  the  specific  gravity  of  the  urine,  will  often  be  found 
very  useful. 

Among  the  pieces  of  accessory  apparatus  which,  with- 
out being  absolutely  indispensable,  are  yet  extremely  im- 
portant, is  the  camera  lucida,  either  in  the  form  of  a  glass 
prism  or  of  the  steel  disk  of  Soemmering,  by  either  of 
which,  when  properly  adjusted  to  the  eye-piece  of  the 
microscope,  with  its  body  placed  horizontally,  images  of 
objects  on  the  field  are  reflected  perpendicularly  down- 
ward, and  if  received  upon  white  paper,  may  readily  be 
traced,  in  outline,  with  a  pencil,  of  almost  any  amplification 
required. 

The  stage  micrometer  is  nothing  more  than  a  slip  of 
glass,  upon  which  are  ruled  a  number  of  lines,  some 
-j-J-o  and  some  ToVo  °f  an  ^nc^  aPai>t  j  it  is  used  to  de- 
termine the  exact  amplifying  power  of  the  various  lenses 
combined  with  different  eye-pieces,  and  for  measuring  the 
magnitude  of  different  objects  as  magnified  upon  the  stage, 


*  Composed  of  Cream  of  tartar          .         .  .96  grains. 

Crystallized  carbonate  of  soda  .96       " 

Sulphate  of  copper     .         .  .  32       " 

Caustic  potash    .         .         .  .  64       " 
Water  2  fluidounces. 


INSTRUMENTS,  AI'/'ARATUS,  ETC.  ;;•.) 

in  the  manner  described  under* the  head  of  Manipulations. 
In  the  absence  of  such  a  standard,  the  red  corpuscles  of 
limit hy  blood,  dried  upon  a  slide,  afford  an  excellent 
natural  substitute.  They  measure  on  an  average  about 
•j^o-g-  of  an  inch  in  diameter. 

Under  the  higher  powers  it  is  often  difficult  to  find  a 
particular  object  mounted  upon  a  slide  without  some  me- 
chanical assistance,  and  I  have  often  seen  much  valuable 
time  wasted  in  a  vain  endeavor  to  hit  upon  a  special  Dia- 
tom or  other  test  object  which  the  microscopist  desired  to 
exhibit. 

When  the  microscope  is  provided  with  the  stage  move- 
ment, an  excellent  method  of  avoiding  this  inconvenience 
is  to  divide  the  brass-work  in  which  the  stage  traverses  by 
small  scratches  upon  the  edges  of  the  grooves  -fa  of  an 
inch  apart,  By  counting  the  number  of  these  divisions  to 
the  right  of  and  above  some  standard  point,  and  noting 
them  upon  the  label  of  the  specimen,  it  is  obviously  easy 
to  replace  the  slide  at  any  future  time  in  the  exact  position 
beneath  the  lenses  which  it  occupied  when  the  required 
object  was  in  the  field  of  view.  Maltwood's  Finder,  a 
very  simple  and  ingenious  contrivance,  for  accomplishing 
the  same  end,  consists  of  the  photograph  of  625  minute 
squares,  and  in  each  of  these  (except  the  center  one)  are 
placed  two  different  numbers,  which,  if  noted,  enable  the 
observer  to  bring  that  particular  square  beneath  the  ob- 
jective at  any  future  time,  when,  of  course,  if  the  finder  be 
removed  and  replaced  by  a  mounted  slide,  any  object  upon 
that  which  has  been  previously  determined  to  occupy  the 
same  relative  position  to  the  lower  left-hand  corner  of  the 
slide  will  appear  in  the  field  of  view. 

For  cutting  thin  sections,  either  of  morbid  growths  or 
healthy  tissues,  Valentine's  double-bladed  knife  is  a  val- 
uable instrument  in  the  hands  of  one  accustomed  to  its 
use  ;  it  consists  of  two  parallel  blades,  so  adjusted  that 


40  MEDICAL  MICROSCOPY. 

their  distance  apart  can  be 'accurately  regulated  by  means 
of  a  screw  and  catch,  and  yet  capable  of  easy  separation, 
for  the  removal  of  the  section  cut,  or  for  the  purpose  of 
cleansing  the  instrument.  By  skilled  operators,  beautiful 
sections  may  be  obtained ;  but  beginners  often  find  at  first 
that  they  can  prepare  no  more  satisfactory  specimens  with 
it  than  they  could  with  a  'sharp  scalpel  and  needles  ;  at 
least  such,  I  confess,  was  my  own  experience. 

Small  scissors,  curved  upon  the  flat,  similar  to  those 
employed  in  ophthalmic  surgery,  are  often  useful  in  the 
preparation  of  thin  sections  from  soft  tissues ;  the  atten- 
uated edge  of  a  minute  fragment  clipped  out  of  the  liver, 
kidney,  etc.  sometimes  affording  a  magnificent  view  of  the 
minute  structure. 

For  cutting  thin  sections  of  hard  tissues,  such  as  bone, 
horn,  etc.,  delicate  saws  are  required,  and  the  specimen 
must  subsequently  be  ground  down  and  polished  upon 
hones  of  different  degrees  of  fineness. 

Glass  dishes  or  gutta-percha  troughs  are  necessary  when 
dissection  of  a  specimen  under  water  is  to  be  carried  on, 
an  operation  which  is  much  facilitated  by  pinning  the 
specimen  to  a  flat  cork,  imbedded  in  a  disk  of  lead,  to  keep 
it  beneath  the  surface  of  the  fluid. 

The  compressorium,  or  its  improved  form  the  Lever 
compressor,  is  highly  recommended  by  Prof.  Beale  for  dem- 
onstrating the  exact  relation  existing  between  the  struct- 
ural elements  of  tissue.  It  enables  the  operator  to  apply 
pressure,  graduated  by  means  of  a  screw,  to  a  specimen 
placed  between  the  two  glasses  until  the  object  is  reduced 
to  an  extreme  degree  of  tenuity. 

The  process  of  minutely  injecting  morbid  tissues  is  so 
rarely  employed  by  any  except  professed  and  experienced 
microscopists,  that  a  brief  reference  to  its  modus  operand! 
is  alone  required  in  this  place.  An  artery  of  considerable 
size  is  to  be  selected,  into  which  one  of  the  separate  inject- 


INSTRUMENTS,  APPARATUS,  ETC.  41 

ing  pipes  is  to  be  inserted  and  tied  securely,  but  not  so 
firmly  as  to  risk  cutting  through  the  arterial  coats;  the 
other  blood-vessels,  except  one  or  two  of  the  veins,  are  to 
be  ligated,  and  arrangements  made  to  stop,  by  means  of 
Bull's  nose  forceps,  such  vessels  as  may  have  escaped 
such  closure.  The  injecting  fluid,  which  maybe  either  the 
Prussian  blue  or  carmine  mixture,  so  highly  lauded  by 
Prof.  Beale,  being  already  prepared,  the  syringe  is  filled 
with  it,  the  nozzle  inserted  in  the  pipe  already  tied  in  the 
mouth  of  the  artery  (great  care  being  taken  to  avoid  the 
passage  of  any  air  into  the  vessel),  and  the  piston  very 
slowly  and  gradually  forced  down,  so  as  to  throw  the  liquid 
into  the  tumor.  After  allowing  the  specimen  to  remain 
undisturbed  a  sufficient  length  of  time,  for  the  non-fluid 
portion  of  the  injection  to  be  absorbed,  incisions  may  be 
made  into  the  substance  of  the  tissue,  and  thin  sections 
cut  from  portions,  which,  when  examined  under  a  magnify- 
ing-glass  or  under  a  low  power,  appear  to  be  well  filled 
with  the  coloring  matter.  It  is  rare  to  find  that  the  in- 
jection has  been  equally  successful  in  all  parts  of  a  morbid 
growth ;  and  the  tyro,  who  feels  almost  disheartened  at 
his  own  failures  when  contemplating  the  exquisite  beauty 
with  which  every  delicate  arterial  twig  is  sometimes 
brought  into  view,  may  find  some  consolation  in  knowing 
that  the  splendidly  injected  section  he  admires  is  perhaps 
one  of  a  fortunate  few  which  could  alone  be  obtained  by 
quite  a  skillful  operator  from  some  large  and  carefully  pre- 
pared specimens. 

The  branch  of  the  niicroscopist's  art  which  relates  to  the 
mounting  of  specimens  for  permanent  preservation,  im- 
portant as  it  is,  does  not  fall  sufficiently  within  the  present 
scope  of  this  work  to  justify  any  extended  exposition  here. 
As,  however,  some  of  my  readers  who  may  happen  to  be 
without  any  more  elaborate  treatise  upon  the  subject  will 
perhaps  feel  desirous  of  preserving  some  remarkable  sped- 


42  MEDICAL   MICROSCOPY. 

mens  they  chance  to  meet  with,  for  future  study,  I  will 
briefly  describe  a  few  of  the  processes  required. 

Mounting  objects  in  the  dry  way  is  a  method  particu- 
larly adapted  to  the  preparation  of  blood  corpuscles  ;  to  the 
various  species  of  acari,  as  the  itch  insect ;  specimens  show- 
ing the  achorion  Schonleinii,  etc.  The  object  is  simply  to  be 
deposited  upon  an  ordinary  glass  slide  in  a  suitable  posi- 
tion, a  thin  glass  cover  laid  gently  upon  it,  and  a  piece  of 
colored  glazed  paper,  perforated  by  a  circular  opening 
somewhat  smaller  than  the  glass  cover,  and  coated  on 
its  under  side  with  mucilage,  pressed  down  over  this 
in  such  a  way  as  to  hold  the  cover  firmly  in  its  place, 
and  at  the  same  time  quite  exclude  dust  and  dirt  from  the 
specimen. 

For  preserving  objects  in  the  wet  way,  that  is,  in  liquid, 
it  is  probable  that  none  of  the  numerous  solutions  which 
have  been  proposed  are  of  such  general  utility  as  glycerin, 
and  I  would  strongly  advise  the  student  to  commence  his 
labors  as  a  mounter  of  specimens  with  it  as  a  preservative 
fluid.  For  this  purpose  the  thin  section  of  any  structure, 
as  for  example  a  carcinomatous  growth,  should  be  placed 
in  a  watch-glass,  filled  with  mixture  of  one  part  of  pure 
water  to  two  of  the  best  glycerin,  and  allowed  to  soak  for 
two  hours.  It  is  then  to  be  removed  upon  a  mounted 
needle,  or  between  a  delicate  pair  of  forceps,  to  another 
watch-glass  containing  pure  glycerin,  in  which  it  should 
be  allowed  to  remain,  carefully  protected  from  dust  by  a 
bell-glass  cover,  for  three  or  four  days,  when  it  will  be 
found  to  occupy  the  volume  it  did  when  fresh,  having  re- 
covered entirely  from  the  shrinking  which  primarily  takes 
place.  If  it  is  desired  to  exhibit  the  nuclei  of  a  tissue  rich 
in  cells,  the  strong  glycerin  may  be  slightly  acidulated  by 
adding  a  drop  of  the  No.  8  acetic  acid  to  two  drachms  of 
the  liquid  ;  or  should  it  be  deemed  desirable  to  stain  the 
"germinal  matter,"  the  section  should  be  first  of  all  im- 


INSTRUMENTS,  APPARATUS,  ETC.  43 

inorsed  in  Dr.  Beale's  carmine  solution*  until  sufficiently 
colored,  great  care  being  used  to  avoid  giving  it  too  deep 
u  tint,  After  remaining  a  sufficient  length  of  time  in 
the  strong  glycerin,  the  specimen  may  be  transferred  to  a 
glass  slide,  properly  arranged,  so  as  to  display  to  the  best 
advantage,  by  means  of  the  mounted  needles,  one  or  two 
drops  of  glycerin  added,  and  a  thin  glass  cover  applied, 
first  by  one  edge,  and  then  its  opposite  margin  gradually 
lowered  down  upon  the  point  of  the  needle  (using  every 
precaution  to  get  rid  of  all  air-bubbles)  until  the  cover  is 
laid  flat  upon  the  slide  with  only  the  specimen  surrounded 
with  a  layer  of  glycerin,  the  excess  (if  unfortunately  there 
is  juiy)  of  which  is  to  be  wiped  off  with  a  soft  cloth, 
slightly  moistened.  The  edges  of  the  cover  should  now 
be  touched  in  three  places  with  cement,  and  when  these 
become  dry,  the  preparation  is  ready  for  sealing  hermeti- 
cally by  applying  over  the  edges  of  the  cover  a  thick  coat- 
ing of  cement,  which  may  be  gold  size,  solution  of  gutta- 
percha  in  chloroform,  sealing-wax  varnish,  etc.,  or,  what 
I  have  found  very  satisfactory,  a  mixture  sometimes  called 
"Hunt's  Cement,"  extensively  used  in  the  Army  Medical 
Museum  at  Washington.  It  is  there,  as  I  am  very 
kindly  informed  by  Col.  J.  J.  Woodward,  prepared  by 
evaporating  Canada  balsam  to  a  solid  consistence,  dis- 

*  "  Carmine        ......      10  grains. 

Strong  liquor  ammoniae  \  drachm. 

Price's  glycerin   .....         2  ounces. 

Distilled  water      .....         2  ounces. 

Alcohol  (?)......         \  ounce. 

Boil  the  carmine  and  liquor  ammonias  (liq.  aminon.,  F.F.F.)  for 
a  few  seconds,  let  stand  an  hour,  add  the  glycerin  (Bower's  will 
answer)  and  water,  filter,  allow  to  settle,  and  pour  off  the  clear 
supernatant  liquid  for  use."  Sections  should  be  immersed  in  this 
for  from  half  an  hour  to  twelve  hours,  according  to  their  softness 
and  succulency ;  they  have  the  great  advantage  of  not  fading 
after  being  mounted,  as  readily  as  if  stained  with  aniline. 


44  MEDICAL  MICROSCOPY. 

solving  it  in  an  equal  bulk  of  benzole,  and  then  thickening 
it  to  about  the  density  of  cream,  with  white-lead  or  zinc, 
ground  in  oil.  A  formula  similar  to  this,  except  in  sub- 
stituting chloroform  for  benzole  as  a  solvent,  was  first  in- 
troduced into  general  use  here  by  Dr.  J.  Gibbons  Hunt,  of 
this  city,  who  recommended  it  at  the  meeting  of  the  Bio- 
logical and  Microscopical  Section  of  the  Academy  of 
Natural  Sciences  of  Philadelphia,  held  April  19,  1869. 
(See  Transactions.)  It  is  furnished  by  Messrs.  J.  W. 
Queen  &  Co.  at  50  cents  per  bottle,  containing  about  an 
ounce. 

The  preparation  of  gold  and  silver  stainings,  after  the 
methods  of  Cohnheim  and  Yon  Recklinhauseii,  for  the 
purpose  of  exhibiting  the  stomata  in  the  walls  of  blood- 
vessels, the  parietal  nuclei  of  capillaries,  and  the  fixed 
corpuscles  and  ultimate  nerve-fibers  of  the  cornea,  etc.,  is 
accomplished  by  soaking  the  perfectly  fresh  tissues  from 
one  to  ten  minutes  in  half  per  cent,  solutions  of  chloride 
of  gold  or  nitrate  of  silver,  washing  in  pure  water,  and 
exposing  to  diffused  daylight  for  twenty-four  hours,  and 
then  mounting  in  glycerin.  (See  a  very  instructive  paper 
by  Wm.  F.  Norris,  M.D.,  in  the  Transactions  of  the  Bio- 
logical and  Microscopical  Section  of  the  Academy  of  Natu- 
ral Sciences,  Medical  Times,  Philadelphia,  Oct.  1870.) 

Having  thus  described — too  briefly,  perhaps,  in  some  in- 
stances— the  most  important  forms  of  the  microscope  and 
its  accessory  apparatus,  1  shall  now  attempt  to  introduce 
the  student  to  the  methods  of  employing  them  in  the 
practice  of  medical  microscopy,  and  as  this  use  can  be 
doubtless  best  illustrated  by  describing  the  steps  of  an 
actual  examination,  I  propose  to  narrate  in  detail  all  the 
minutiae  connected  with  investigating  a  drop  of  saliva, 
selecting  that  as  a  secretion  which  can  always  be  readily 
obtained,  and  one  which  affords  good  test  objects  for  both 
the  high  and  low  powers  of  the  microscope. 


INSTRUMENTS,  APPARATUS,  ETC.  45 

Supposing,  now,  that  the  student,  a  complete  tyro  in 
the  art,  has  procured  a  Woodward's  microscope  (or  some 
other  of  the  cheaper  forms  of  the  instrument),  half  a 
dozen  glass  slides,  as  many  thin  glass  covers,  and  a  bottle 
of  aniline  solution, — how  shall  he  go  to  work  at  putting 
his  treasures  to  practical  use  ?  In  the  first  place,  select  a 
firm,  steady  table,  stationed  before  a  window,  preferably 
with  a  northern  exposure  (as  being  always  free  from  direct 
sunlight),  and  seating  yourself  so  as  to  have  your  left 
shoulder  toward  the  window,  remove  the  instrument  from 
its  case,  and  place  it  before  you  in  about  the  position  shown 
in  Fig.  1,  inclining  it  at  such  an  angle  that  the  eye  conven- 
iently adapts  itself  to  the  top  of  the  tube  without  stooping 
over  and  so  contracting  your  chest;  then  screw  on  the 
longer  lens  (No.  1)  to  the  lower  end  of  the  microscope 
body,  and  slip  the  eye-piece,  if  not  already  there,  into  the 
opening  of  the  upper  extremity,  turn  the  revolving  dia- 
phragm until  the  next  to  the  smallest  hole  is  opposite  the 
center  of  the  aperture  of  the  stage  and  adjust  the  mirror 
beneath  at  such  an  angle  that  the  light  from  the  window 
falling  upon  it  is  reflected  upward  through  the  hole  in  the 
diaphragm,  and  the  glasses  occupying  each  extremity  of 
the  microscope  body,  into  the  eye  applied  closely  to  the 
eye-glass  of  the  eye-piece. 

Next  proceed  to  prepare  an  object  for  examination  by 
accumulating  a  little  saliva  in  the  mouth  (rubbing  the 
tongue  against  the  teeth  pretty  strongly  to  scrape  off 
some  of  the  epithelial  cells),  and  letting  a  drop  fall  from 
the  tip  of  the  tongue  upon  the  middle  of  a  clean  glass 
slide;  cover  it  by  laying  gently  upon  it  a  square  (or 
circle)  of  thin  glass,  and  absorb  the  surplus  fluid,  by  bring- 
ing in  close  contact  with  it  the  corner  of  a  soft  linen  or 
muslin  rag,  then  place  a  very  small  drop  of  the  aniline 
solution  (or  of  tincture  of  iodine)  at  the  lower  right-hand 

5 


46  MEDICAL   MICROSCOPY. 

angle  of  the  thin  glass  cover,  so  that  a  little  of  it  may  run 
in  between  the  two  glasses,  and  thus  tint  the  saliva  and  its 
contents  at  that  part  a  crimson  or  yellowish-brown,  accord- 
ing as  the  former  or  latter  reagent  has  been  employed  to 
render  the  epithelium,  etc.  more  distinct. 

Now  place  the  slide  thus  prepared  upon  the  stage,  raising 
up  the  spring  clips,  and  slipping  it  under  them,  so  that 
by  their  pressure  they  may  prevent  it  from  becoming  dis- 
placed ;  push  it  down  beneath  the  springs  until  the  corner 
of  the  cover  to  which  aniline  has  been  applied  occupies 
the  middle  of  the  little  circle  of  light  allowed  by  the  dia- 
phragm to  pass  up  from  the  mirror,  then  slide  the  body  of 
the  microscope  downward  in  the  tube  which  carries  it, 
until  the  objective,  at  its  lower  extremity,  is  within  about 
one-eighth  of  an  inch  of  the  surface  of  the  glass  cover 
(this  you  can  best  determine  by  bringing  the  eye  down  to 
a  level  with  the  stage  and  looking  at  the  window  between 
the  lens  and  the  slide) ;  then,  looking  through  the  eye- 
piece at  the  top  of  the  body,  raise  the  latter  very  slowly 
by  screwing  it  round,  at  the  same  time  that  you  draw  it 
iipward  gently,  until  the  corner  of  the  cover  (recognized 
by  its  appearing  like  the  upper  left-hand  angle — because 
apparently  inverted  by  the  microscope — of  a  slab  of  glass 
such  as  is  used  for  skylights  in  floors)  comes  into  view ; 
when  you  may  focus  it, — that  is,  raise  and  lower  the 
lenses  until  you  find,  by  repeated  trials,  the  exact  distance 
at  which  you  can  see  it  most  plainly,  by  means  of  the  fine 
adjustment,  turning  the  milled  head  to  the  right  or  to  the 
left,  according  as  you  find  necessary  to  increase  or  de- 
crease the  space  between  the  objective  and  the  object; 
you  will  soon  discover,  on  attentively  studying  this  corner 
of  the  thin  glass,  that  (speaking  of  the  field  as  if  it  were  a 
map)  the  little  particles  of  dust,  etc.  upon  the  glass  to  the 
north,  northwest,  and  west  of  the  angle  require  the  micro- 
scope body  to  be  depressed  farther  than  those  toward  the 


INSTRUMENTS,  APPARATUS,  ETC.  47 

southeast  of  the  same  point;  this  is  due  to  the  thickness 
of  the  covering  glass.  After  adjusting  the  focus  so  that 
some  little  particle  upon  the  slide  itself  is  plainly  visible, 
take  hold  of  the  ends  of  the  slide  with  the  fingers  and 
thumbs,  and  slip  it  very  slowly  in  a  diagonal  direction,  so 
that  the  angle  of  the  cover  appears,  through  the  micro- 
scope, to  move  toward  the  northwest  part  of  the  field  ; 
continue  this  motion  as  far  as  the  middle  of  the  cover, 
and  then  reverse  the  movement  (with  such  slight  varia- 
tion as  will  avoid  repassing  over  the  same  surface),  and 
so  proceed  until  you  find  a  body  resembling  the  larger  of 
those  depicted  in  Fig.  4,  or 
until  you  are  satisfied  no  IG>  ' 

such  object  exists  upon  the 
slide,  when  it  may  be  laid 
away  and  a  new  one  pre- 
pared. Presuming,  how- 
ever, that  you  are  success- 
ful in  discovering  such  a 
body  as  that  figured  (an 
epithelial  cell  from  the  mu- 
cous membrane  lining  the  Squamous  epithelial  cells,  salivary 
, ,  .  .,  ..,,  ,  ,  n  -,  corpuscles,  and  filaments  of  fungi  in  a 

niOUth),  It  Will   not  be  found    drop  of  saliva.     Magnified  100  diameters. 

quite  distinct  when  exam- 
ined at  the  focal  distance  for  particles  seen  upon  uncov- 
ered portions  of  the  slide,  so  that  the  body  of  the  in- 
strument must  be  raised  slightly  by  means  of  the  fine 
adjustment  until  its  outlines  are  clear  and  sharp,  and  the 
nucleus — the  dark-red  oval  mass  situated  near  its  center — 
is  bright  and  well  defined.  Then  change  the  objective 
(screwing  on  the  little  one),  bring  down  the  lens  to  about 
-g'o-  of  an  inch  from  the  thin  cover,  and  slowly  raise  it  as 
before,  until  the  cell  is  exactly  in  focus,  moving  the  slide, 
if  necessary,  to  bring  it  to  the  middle  of  the  field,  and 
after  it  has  been  thoroughly  examined,  other  similar  struct- 


48  MEDICAL   MICROSCOPY. 

ures  less  strongly  tinted,  and  then  still  others  (toward 
the  opposite  corner  of  the  cover),  in  a  normal  condition, 
are  to  be  carefully  studied  until  you  become  quite  familiar 
with  that  important  histological  element,  the  Squamous 
Epithelial  cell. 

Since  we  all  perform  any  work  to  which  we  are  unac- 
customed, more  efficiently  when  we  know  why  each  step 
of  a  prescribed  process  is  taken,  and  wherefore  a  seemingly 
similar  operation  is  less  advantageous,  I  will  endeavor  to 
give  a  species  of  commentary  explaining  the  above  direc- 
tions. First,  then,  a  firm,  steady  table  is  to  be  chosen  as 
a  support  for  the  microscope,  not  merely  because  less 
likely  to  be  overturned,  but  because  the  vibrations  com- 
municated from  surrounding  bodies  might  otherwise  cause 
objects  upon  the  slide  to  shake  or  "  dance,"  so  that  they 
could  with  difficulty  be  examined ;  the  microscope  is  to  be 
so  placed  that  the  light  falls  upon  its  mirror  from  the  left, 
because  on  that  side  the  right  hand  manipulating  the 
object  upon  the  stage  does  not  obscure  the  light;  some 
microscopists  prefer  to  sit  in  front  of  a  window,  but  such 
a  position  is  not  quite  so  convenient  when  very  oblique 
illumination  is  to  be  employed.  Working  by  gas-  or  lamp- 
light is  much  more  trying  to  the  eyes,  but  except  on  that 
account  I  have  not  found  it  objectionable,  and  have  often 
employed  such  illumination  for  three  or  four  hours  of  an 
evening  without,  as  yet,  apparent  injury ;  the  yellow  tint 
of  the  flame  may  be  corrected  by  passing  it  through  a 
shade  of  light-blue  glass,  by  wearing  blue  spectacles,  or 
by  having  a  blue  glass  (night)  cap  for  the  microscope. 
Before  screwing  on  the  lenses  and  inserting  the  eye-piece, 
you  should  always  see  that  no  little  particles  of  dirt  or 
fibers  of  cotton  adhere  to  the  glass, — should  they  do  so, 
breathe  gently  upon  the  surface  and  wipe  clean  with  a  soft 
rag  or  piece  of  buckskin.  Particles  of  dust  upon  the  eye- 
piece, which  often  appear  as  objects  upon  the  field  of  view, 


INSTRUMENTS,  APPARATUS,  ETC.  49 

may  be  recognized,  by  revolving  as  the  eye-piece  is  turned 
round  in  its  socket.  The  second  small  hole  of  the  dia- 
phragm is  advised  because,  while  admitting  sufficient 
light,  it  does  not  render  the  field  too  bright  to  see  faint 
markings ;  but  the  other  apertures  should  be  tried  in  suc- 
cession, so  as  to  become  familiar  with  the  results  of  differ- 
ent illumination ;  sometimes  there  is  a  little  difficulty  in 
throwing  the  light  from  the  mirror  up  the  tube,  but  it  is 
soon  overcome  by  practice. 

In  preparing  a  specimen  of  saliva,  it  is  well  to  make 
sure  that  you  have  something  besides  transparent  liquid 
by  observing  whether  any  little  faint,  grayish  particles, 
just  visible  to  the  naked  eye  when  the  slide  is  held  ob- 
liquely, are  to  be  seen  beneath  the  thin  glass;  if  not,  it  is 
better  to  wash  off  the  slide  and  prepare  another  specimen ; 
of  course  the  particles  detected  by  the  unassisted  vision 
are  not  single  epithelial  cells,  but  may  be  aggregations  of 
them,  or  what  is  more  probable,  tiny  fragments  of  food,  to 
which  both  epithelial  cells  and  salivary  corpuscles  are  often 
attached.  The  excess  of  saliva  should  be  absorbed  from 
the  margin  of  the  thin  glass,  simply  because  if  the  latter 
merely  floats  lightly  upon  a  drop  of  fluid  buoyed  up  be- 
yond capillary  attraction's  sphere  of  action,  it  is  apt  to 
glide  off  when  the  slide  is  inclined  to  place  it  on  the  micro- 
scope stage  ;  at  the  same  time  care  must  be  taken  not 
to  press  upon  the  cover  with  the  cloth,  or  to  push  it  along 
while  absorbing  the  moisture,  lest  the  delicate  structures  in 
the  saliva  be  crushed  or  rolled  together,  and  so  rendered 
indistinguishable.  The  addition  of  aniline  or  iodine  solu- 
tion is  only  intended  to  render  the  epithelial  cells  more  dis- 
tinct, to  a  novice,  and  prevent  their  being  overlooked  ;  of 
the  two  liquids,  aniline  gives  the  brightest  tint,  but  iodine 
(see  page  3*7)  does  very  well;  or  the  experiment  may  be 
first  tried  without  any  coloring  matter,  if  neither  of  those 
mentioned  is  at  hand. 

5* 


50  MEDICAL   MICROSCOPY. 

In  putting  the  slide  upon  the  stage,  be  careful  not  to 
push  it  against  the  spring  clips  so  that  they  will  disarrange 
the  cover,  as  sometimes  occurs ;  the  pressure  of  these 
springs  should  be  just  sufficient  to  prevent  the  slide  from 
slipping  out  of  place,  and  yet  allow  of  its  being  freely 
moved  by  the  fingers  as  desired.  The  lower  right-hand  cor- 
ner of  the  square  cover  (no  better  than  any  other  corner,  but 
chosen  to  render  the  subsequent  directions  more  explicit), 
or  the  corresponding  edge  of  a  thin  glass  circle,  is  selected 
merely  as  being  a  well-defined,  always  present  object,  and 
therefore  a  suitable  guide  to  the  adjustment  of  the  focus, 
that  great  difficulty  with  beginners.  The  method  advised 
of  bringing  the  objective  close  to  the  thin  cover,  but  just 
not  touching,  and  then  raising  it  till  you  find  the  focus,  is 
the  one  I  generally  resort  to  with  high  powers,  and  con- 
sider it  far  safer  for  both  objective  and  specimen  than  the 
opposite  plan  of  seeking  for  the  focus  from  above  by  de- 
pressing the  microscope  body  until  the  object  comes  clearly 
into  view ;  I  have  seen  a  valuable  y1^  inch  lens  ruined  by 
being  screwed  down  against  the  glass  slide,  "  Focusing" 
an  object  by  means  of  the  fine  adjustment  is  nothing  but 
a  series  of  experiments  (performed  by  turning  the  knob 
back  of  the  tube),  the  aim  of  which  is  to  decide  whether  the 
object  to  be  examined  can  be  seen  most  distinctly  when  the 
lenses  are  the  hundredth  or  the  thousandth  of  an  inch 
nearer  to  or  farther  from  it.  The  purpose  of  the  coarse 
adjustment  (made  in  this  instrument  by  sliding  the  body 
in  the  tube  which  carries  it)  is  to  regulate  the  distance 
within  perhaps  the  -fa  Of  an  inch,  after  which  the  fine  ad- 
justment is  brought  into  play  to  place  the  object  exactly 
in  focus.  What  is  called  Transitional  focusing  consists  in 
a  rapid  alteration,  by  quick  turns  of  the  screw,  of  the  dis- 
tance between  objective  and  object,  causing  the  latter  to 
be  at  one  moment  just  within,  and  at  another  just  outside, 
the  point  of  clearest  definition  ;  it  is  often  of  great  assist- 


.   APPARATUS,  ETC.  51 

ance  in  detecting  difficult  details  of  structure.  In  seeking 
to  bring  atoms  of  dust  upon  the  slide  into  view,  the  student 
may  be  puzzled  for  a  moment  by  finding  that  numerous 
particles  are  to  be  seen  to  the  southeast  of  the  angular 
corner,  while  the  north,  northwest,  and  west  parts  of  the 
field  are  perfectly  transparent;  or  he  may  find  nothing 
visible  in  the  field  but  the  rectangular  dark  margins  of  the 
cover  showing  their  peculiar  conchoidal  fracture.  He  must 
not,  however,  conclude  in  the  first  case  that  there  is  no 
dust  upon  the  slide  ;  nor  in  the  second,  that  there  is  none 
upon  either  slide  or  cover ;  for,  by  simply  depressing  the 
body  of  the  microscope,  he  will  probably  discover  some 
minute  fragments  of  dirt  or  scratches  upon  the  glass  to  the 
north  west  of  the  angle,  although,  if  the  directions  are  strictly 
observed,  he  will  not  be  apt  to  meet  with  such  a  difficulty, 
but  will  perceive  (should  the  slide  be  properly  placed),  as 
he  raises  the  tube  of  the  instrument,  the  rectangular  corner 
of  the  glass  cover  at  first  cloudy  and  indistinct,  but  grad- 
ually becoming  more  sharply  defined,  until  particles  or 
scratches  begin  to  appear  in  a  northwest  direction  from  it. 
The  reason  that  dust  upon  the  slide  is  best  seen  with  a 
longer  focus  when  covered  with  thin  glass  than  when  un- 
covered, is  that  the  rays  of  light  reaching  the  lens  with  a 
greater  divergence  after  traversing  strata  of  glass  and  of 
air  than  after  passing  through  air  alone,  require  an  increase 
of  the  focal  distance  to  cut  off  the  too  divergent  rays,  and 
so  produce  distinct  vision. 

If,  in  spite  of  these  prolix  iastructions,  you  fail,  firstly,  to 
detect  a  corner  of  the  thin  glass  cover,  it  is  probably  be- 
cause it  is  not  exactly  in  the  field,  and  to  remedy  this  you 
must  arrange  the  objective  as  before,  about  the  £  of  an 
inch  from  the  upper  surface  of  the  cover,  and  change  the 
place  of  the  slide  a  little,  at  the  same  time  that  you  look 
through  the  microscope,  until  you  perceive,  by  the  sudden 
diminution  of  the  light,  that  some  opaque  substance  is 


52  MEDICAL  MICROSCOPY. 

below  the  lens ;  on  focusing,  by  raising  the  body  of  the 
instrument,  you  will  either  find  the  margin  of  the  cover  or 
some  object  upon  the  slide  which  will  enable  you  to  adjust 
the  instrument  to  its  focal  distance ;  when,  by  moving  the 
slide  about  in  various  directions,  you  will  soon  bring  the 
edge  of  the  cover  into  view,  and  following  it  along,  come 
to  the  sought-for  corner.  Secondly,  after  finding  this 
angle  of  the  thin  glass,  you  may  have  some  difficulty  in 
detecting  any  little  particles  of  dust  as  guides  to  the  proper 
focus  of  objects  on  the  slide ;  in  which  event  raise  up  the 
body  of  the  microscope,  remove  the  slide,  sprinkle  on  the 
tinted  corner  a  little  dust,  common  flour,  or  any  other  fine 
powder,  and  having  replaced  it  upon  the  stage,  proceed  as 
at  first  directed.  Thirdly,  the  slide  which  you  have  prepared 
may  happen  to  contain  no  epithelial  cells,  in  which  case 
wash  it  off,  wipe  the  glasses,  and  prepare  another  speci- 
men, which  can  hardly  be  equally  barren.  You  must  not 
suppose,  as  some  are  inclined  to  do,  that  reading  over  any 
instructions  whatsoever,  will  enable  one  to  become  a  good 
observer,  for  there  is  no  more  a  royal  road  to  microscopy 
than  to  any  other  branch  of  learning,  and  it  is  only  as  you 
are  willing  to  try  and  try  and  try  again,  carefully  and 
patiently,  that  you  can  hope  to  become  skillful  in  this 
most  delightful  occupation. 

Having  become  familiar  in  the  manner  described  above 
with  the  scalelike  epithelial  cell,  first  in  its  tinted,  and 
afterward  in  its  normal  conditions,  as  seen  with  a  power 
of  350  diameters,  the  young^microscopist  should  render 
himself  intimately  acquainted  with  the  other  ingredients 
of  the  saliva,  by  preparing  a  fresh  slide  without  the  addi- 
tion of  any  coloring  material,  and  having  brought  its  sur- 
face into  focus,  and  found  an  epithelial  scale,  should  care- 
fully examine  the  rest  of  the  field  for  some  small  nucleated 
granular  bodies,  a  little  larger  than  the  nuclei  of  the  epithe- 
lium, but  differing  from  them  in  being  spherical  instead  of 


INSTRUMENTS,  APPARATUS,  ETC.  53 

oval  (sec  Fig.  4)  ;  if,  however,  none  are  to  be  seen,  change 
the  field  by  moving  the  slide  very  slowly,  as  suggested 
above,  until  one  or  more  are  detected.  These  bodies  are 
the  salivary  corpuscles,  formerly  supposed  to  be  peculiar 
4,0  the  saliva,  but  which  I  have  shown  to  be  simply  dis- 
tended white  blood  globules.  (See  Chap.  VIII.;  also  Fig. 
10.)  They  constitute  the  best  convenient  test  for  objectives, 
ranging  in  magnifying  powers  from  200  to  1200  diameters, 
with  which  I  am  acquainted.  If,  with  your  Woodward's 
microscope,  you  can  plainly  see  the  one,  two,  or  three  nuclei 
of  an  untinted  corpuscle,  you  may  feel  well  satisfied  with  its 
performance ;  and  should  you  be  able  to  detect  the  motion 
of  the  molecules  it  contains  (see  Chap.  VIII.),  you  have 
been  fortunate  enough  to  obtain  a  superior  instrument. 

In  searching  for  the  salivary  corpuscles,  you  may  per- 
haps observe  some  very  faintly  outlined,  rounded,  or  irreg- 
ular masses,  occupying  from  a  small  part  to  a  whole  field, 
or  even  more,  made  up  of  extremely  delicate  threads,  some 
of  which,  on  close  scrutiny,  will  be  seen  to  have  a  more  or 
less  active  vibrating  motion  ;  these  are  filaments  of  the 
Leptothrix  buccalis  of  Ch.  Robin  (by  Hallier  and  others 
believed  to  be  one  form  of  Penicillium),  and  are  best  studied 
by  removing  a  minute  portion  of  the  tartar  which  accumu- 
lates between  the  teeth  when  it  cannot  be  reached  by  the 
brush,  and  examining  it  in  saliva;  the  filaments  sometimes 
grow  from  old  epithelial  cells,  as  shown  in  Fig.  4.  It  is 
also  important  to  become  familiar  with  the  appearance  of 
air  bubbles  beneath  the  thin  glass,  which  I  have  known 
to  be  mistaken  by  novices  for  some  extraordinary  struct- 
ures; when  small,  they  are  usually  circular  (see  Fig.  14), 
and  even  if  large,  their  margins  are  generally  composed  of 
segments  of  curves ;  if  you  find  difficulty  in  detecting  them, 
move  the  slide  so  that  some  portion  of  the  upper  edge  of 
the  cover  is  in  the  field,  and  wait  a  few  minutes  until  the 
fluid  begins  to  dry  away,  when  the  air  will  enter  to  supply 


54  MEDICAL  MICROSCOPY. 

its  place  and  afford  you  an  excellent  opportunity  to  study 
the  characters  of  its  bubbles.  After  becoming  acquainted 
with  these,  you  should  compare  them  very  carefully  with 
oil  globules  (which  they  sometimes  strongly  resemble)  by 
examining  a  drop  of  milk  or  by  rubbing  a  little  oil  and 
water  together  (moving  a  thin  glass  cover  backward  and 
forward  over  such  a  mixture  until  it  becomes  milky),  when 
you  will  find  not  only  oil  globules  and  air  bubbles,  but 
also  globes  of  oil  containing  air,  all  of  which  will  furnish 
you  very  profitable  objects  of  study.  If  you  have  any 
difficulty  in  distinguishing  them,  add  a  little  aniline  solu- 
tion, by  which  the  oil  will  become  more  or  less  tinted,  while 
the  air  bubbles,  of  course,  will  be  left  colorless  in  the  crim- 
son fluid  which  surrounds  them. 

There  are  many  other  elements  more  or  less  accidental, 
which  you  may  happen  to  meet  with  in  saliva,  all  worthy 
of  attentive  examination,  as  most  of  them  may  occur  in 
the  various  secretions  of  the  human  system,  and  each 
present  to  *you  a  separate  enigma;  such,  for  example,  as 
portions  of  food,  among  the  most  common  of  which  are 
granules  of  wheat,  rice,  and  potato  starch,  fibers  of 
celery,  spinach,  and  cabbage,  and  fragments  of  muscle 
(see  Fig.  14),  elastic  tissue,  etc.  from  the  different  domestic 
animals ;  or,  again,  particles  from  clothing,  such  as  fila- 
ments of  silk,  cotton,  or  wool,  hairs  of  various  animals 
(see  Fig.  20),  pollen  grains,  animalcula,  ova,  and  spores 
of  a  multitude  of  minute  organisms  which  constantly  float 
in  the  atmosphere  (see  Prof.  Tyndall's  late  experiments), 
and  being  inhaled  at  every  breath,  are  frequently  deposited 
upon  all  parts  of  the  respiratory  passages ;  with  an  abun- 
dance of  other  objects  too  numerous  to  mention,  and  only 
to  be  learned  by  faithful  and  persevering  study. 

Modifications  of  the  method  for  examining  a  slide  of 
saliva  as  directed  above,  which  are  requisite  when  the 
student  has  the  use  of  a  more  complete  and  expensive  in- 


INSTRUMENTS,  APPARATUS,  ETC.  55 

strumrnt,  arc  neither  very  great  nor  very  numerous,  the, 
main  principles  of  construction  being  similar  in  almost  all 
compound  achromatic  microscopes.  If,  for  example,  you 
can  command  a  Zentmayer's  Grand  American  Microscope 
(Fig.  3),  you  may  proceed  with  it,  placed  as  above  directed, 
using  the  concave  mirror  to  reflect  the  light,  screwing  on 
at  first  the  H  inch  objective  to  the  lower  extremity  of 
the  microscope  body  and  slipping  the  No.  1  eye-piece  into 
its  upper  end.  Then  lay  the  prepared  slide  upon  the  stage, 
by  means  of  the  milled  heads  just  below  it,  bring  the  south- 
cast  corner  of  the  cover  opposite  the  circle  of  light  from 
the  diaphragm,  and  having  depressed  the  objective  to 
within  £  of  an  inch  (instead  of  £)  of  the  surface  of  the 
cover  by  means  of  the  coarse  adjustment,  slowly  raise  it 
a --a in  until  the  angle  of  the  thin  glass  comes  in  sight, 
when,  if  necessary,  the  stage  should  be  moved  by  means 
of  its  adjusting  screws  until  that  particular  corner  occupies 
the  center  of  the  field  of  view,  after  which  you  may  change 
the  eye-piece  for  No.  3  (giving  a  power  of  about  100  diam- 
eters), and  proceed  to  look  up  an  epithelial  cell  as  before 
suggested.  In  order  to  study  the  cell  satisfactorily,  how- 
ever, you  must  examine  it  more  highly  magnified,  to  ac- 
complish which,  bring  it  to  the  exact  center  of  the  field, 
unscrew  the  1 J  inch  objective,  and  remove  the  No.  3  eye- 
piece, replacing  them  by  the  i  inch  and  the  No.  1  re- 
spectively, depress  the  microscope  body  until  the  objective 
is  within  -fa  of  an  inch  of  the  thin  glass  cover,  and  then 
gradually  elevate  the  lens  until  you  obtain  the  right  focus; 
if  the  epithelial  cell  is  not  visible,  move  the  stage  (by 
turning  its  milled  heads)  north,  south,  east,  and  west,  until 
you  find  it  or  some  other  equally  satisfactory,  which  you 
ma}^  study  under  magnifying  powers  of  about  500  and  700, 
by  exchanging  the  eye-piece  for  No. -2  or  No.  3,  without 
disturbing  the  objective.  The  chief  advantages  (beside 
those  derived  from  superiority  of  lenses)  being,  you  ob- 


56  MEDICAL   MICROSCOPY. 

serve,  the  much  greater  ease  with  which  you  will  find  any 
required  object  under  a  lower  power,  and  by  the  aid  of  the 
stage  movement,  coupled  with  the  far  better  illumination 
from  the  large  mirror. 

If,  after  a  good  deal  of  practice  with  the  lower  powers, 
— that  is,  those  of  more  than  J  of  an  inch  focal  length, — 
the  niicroscopist  determines  to  procure  a  still  higher  objec- 
tive, he  will  very  probably,  as  intimated  above,  be  at  first 
disappointed  with  its  performance  ;  but  gradually  (speak- 
ing from  my  own  experience,  at  least)  one  object  after 
another  will  dawn  upon  him,  until  before  long  he  finds 
himself  most  bountifully  repaid  for  all  his  expenditure  of 
time  and  money ;  in  fact,  I  think  it  becomes  daily  more 
and  more  evident  that  it  is  only  with  such  very  powerful 
lenses  that  we  can  hope  to  penetrate  some  of  the  most 
important  secrets  of  life,  disease,  and  death  which  have 
hitherto  eluded  our  best  efforts.  I  have  found  the  man- 
agement of  the  -fa  and  -^  beset  with  no  especial  difficul- 
ties, only  requiring  a  much  higher  degree  of  the  same  cau- 
tion, gentleness,  and  patience  necessary  in  handling  the 
1  inch  objective.  In  the  first  place,  the  glass  covers  must 
be  much  thinner,  averaging  about  ^-Q  for  the  -fa,  and  -g-J-Q 
for  the  -5*0,  and  these  must  be  handled,  of  course,  with 
the  greatest  delicacy  ;  again,  although  sections  of  kidney, 
liver,  etc.  may  be  readily  cut  of  sufficient  tenuity  for  ex- 
amination with  the  former  of  those  objectives,  it  is  no 
easy  matter  to  prepare  them  for  the  latter.  The  achro- 
matic condenser  for  increasing  the  light  upon  the  object  is 
absolutely  necessary ;  and  when  using  the  -fa,  even  the 
Argand  burner,  if  gas  illumination  is  employed,  must  be 
brought  very  close  to  the  mirror.  Instead  of  merely 
bringing  the  front  lens  of  the  combination  within  fa  of  an 
inch  of  the  cover,  it  must  be  depressed  until  the  most 
slender  line  of  light  (reflected,  say,  from  a  piece  of  white 
paper  or  muslin,  held  on  a  level  with  the  eye,  on  the  op- 


INSTRUMENTS,  APPARATUS,  ETC.  57 

posite  side  of  (lie  sta^v),  not  thicker  than  the  thinnest 
tissue-paper,  is  visible  between  them.  Great  cure  must  be 
taken  to  focus  with  only  the  lightest  touches  upon  the  line 
adjustment  screw,  and  it  is  a  good  plan  to  begin  your  ob- 
servations with  examining  a  specimen  of  fluid  blood, 
since,  in  that  case,  if  in  a  moment  of  forgetful  ness  you 
screw  down  the  objective  in  contact  with  the  glass,  your 
attention  is  called  to  the  fact  before  any  damage  is  done 
by  seeing  the  globules  rush  madly  across  the  field  until 
lost  to  view  beyond  its  margin.  And  lastly,  in  survey- 
ing a  large  surface  by  the  aid  of  the  stage  movement,  you 
must  be  constantly  on  the  watch  lest,  running  a  little  un- 
evenly, it  may  cause  particles  of  dust  upon  the  cover  to 
rub  and  scratch  the  surface  of  the  front  combination. 

The  method  of  working  with  Immersion  lenses  has  been 
already  alluded  to,  and  is  accomplished  without  particular 
difficulty.  The  object  to  be  viewed  should  be  not  far 
from  the  center  of  a  rather  large  cover,  in  order  that  the 
fluid  which  bathes  it  may  not  be  brought  in  contact  with 
that  in  which  the  lens  is  immersed,  or  they  will  immedi- 
ately become  mixed  by  capillary  attraction  ;  after  placing 
the  slide  upon  the  stage,  the  instrument  being  set  verti- 
cally, a  clean  glass  rod  is  to  be  dipped  into  distilled  water 
(fresh  rain-water  will  answer  every  purpose)  and  applied 
to  the  cover  so  as  leave  a  small  drop  just  over  the  circle 
of  light  concentrated  by  the  achromatic  condenser ;  next 
screw  down  the  body  of  the  instrument  until  the  objec- 
tive comes  in  contact  with  the  fluid,  and,  if  requisite,  a 
little  farther,  watching  it  carefully  with  the  eye  held  on  a 
level  with  the  stage  to  avoid  going  too  far,  and  then  in- 
cline the  microscope  as  preferred  and  focus  as  above  ad- 
vised. It  is  necessary  to  renew  the  distilled  water  at 
intervals  of  perhaps  an  hour  by  carrying  another  drop  to 
the  upper  edge  of  the  lens  by  means  of  the  rod  and  letting 
it  flow  in  to  supply  the  place  of  that  which  has  evapo- 

6 


58  MEDICAL   MICROSCOPY. 

rated ;  the  observer  will  be  informed  of  this  desiccation 
by  seeing  a  sort  of  cloud  fly  rapidly  across  the  field  of 
view,  after  which  passage  objects  seen  clearly  before  be- 
come suddenly  indistinct.  It  has  occurred  to  me  that  a 
lens  so  adjusted  as  to  give  a  clear  image,  when  immersed 
in  glycerin,  would  have  some  advantages,  such  as  avoid- 
ance of  this  drying  away  of  the  fluid,  and  on  account  of 
the  higher  refractive  power  of  the  liquid,  increased  ampli- 
fication, and  greater  working  distance  ;  perhaps,  however, 
some  different  cement  for  the  lenses  would  be  required. 
It  has  been  objected  that  immersion  lenses  are  less  dura- 
ble than  others,  on  account  of  even  water  in  time  disinte- 
grating the  cement  employed,  but  my  -^  has  been  in 
almost  daily  use,  not  unfrequently  for  several  hours  a  day, 
and  often  as  an  immersion  lens,  without  any  sensible  dete- 
rioration. 

Dr.  Beale  very  judiciously  advises  that  the  young  micro- 
scopist  should  guard  against  injuring  ^his  sight  by  work- 
ing at  first  with  low  powers,  rather  feeble  illumination,  and 
for  only  short  periods  at  a  time,  always  ceasing  his  efforts 
as  soon  as  the  eyes  become  fatigued,  which  may  be  in  fif- 
teen or  twenty  minutes  at  first,  although  by  practice  he 
can  observe  for  four  or  five  hours  without  cessation ;  he 
should  learn  as  rapidly  as  possible  to  work  with  both  eyes 
open  and  with  either  eye  at  pleasure.  The  microscope 
should  be  covered  with  a  glass  shade  (or  a  cone  of  glazed 
paper),  when  not  in  use,  to  protect  it  from  dust.  The 
front  combinations  of  all  objectives  may  be  cleaned  by 
breathing  on  them  gently  and  wiping  them  carefully  with 
a  soft  linen  rag  or  old  silk  handkerchief  which  is  quite  free 
from  particles  of  dust ;  the  compound  lenses  which  make 
up  the  objectives  of  J  inch  focal  length  and  over  may  be 
screwed  apart  and  polished  in  the  same  way,  but  the 
higher  powers  should  be  sent  to  an  optician  when  they 
become  dirty. 


INSTRUMENTS,  APPARATUS,  ETC.  f>!) 

Presuming  that  the  student  who  has  faithfully  followed 
the  instructions  above  given  will  have  become  sufficiently 
familiar  with  tin1  nnxliix  operandi  to  adapt  my  further 
directions  to  his  own  instrument,  oven  if  different,  I  shall 
describe  the  remaining  manipulations  with  less  tedious 
minuteness. 

Objects  magnified  beneath  the  microscope  may  be  drawn 
by  placing  a  piece  of  paper,  supported  on  cardboard,  ex- 
actly on  a  level  with  the  stage,  and  looking  with  one  eye 
through  the  instrument  and  the  other  at  the  paper,  when, 
after  a  little  practice,  the  image  will  seem  to  be  projected 
on  the  paper,  and  may  be  drawn  with  a  pencil.  With  ;i 
camera  lucida  or  steel  disk  this  can  be  done  much  more 
satisfactorily,  placing  the  body  of  the  microscope  in  a 
horizontal  position  (previously  clamping  the  glass  slide  so 
that  it  may  not  drop  forward),  slipping  the  camera  on  the 
eye-piece,  and  adjusting  the  paper  upon  the  table  beneath. 
Some  persons  find  a  difficulty  in  seeing  the  point  of  the 
pencil  at  the  same  time  with  the  object,  usually  either 
from  having  the  paper  too  shaded  or  else  too  strongly 
illuminated,  or  from  trying  to  draw  something  in  the  mid- 
dle instead  of  at  the  edge  of  the  field.  If  the  drawing  is 
desired  smaller  than  the  magnified  object,  the  distance 
from  the  camera  to  the  table  must  be  less  than  that  from 
the  top  of  the  eye-piece  to  the  stage  ;  if  the  same  size,  this 
must  be  equal,  and  if  larger  (as  for  class  demonstration), 
you  must  place  the  instrument  so  that  the  eye-piece  pro- 
jects over  the  edge  of  the  table,  and  the  image  is  thrown 
upon  paper  placed  on  a  chair  or  on  the  floor,  and  draw  with 
a  long  pencil. 

To  measure  the  size  of  a  magnified  object  as  enlarged 
by  any  particular  combination  of  eye-piece  and  objective, 
if  you  have  either  a  slide,  or  cobweb,  eye-piece  micrometer, 
is  very  easy  after  you  know  to  what  the  divisions  are 
equivalent ;  thus,  for  example,  should  you  find  that  with 


GO  MEDICAL  MICROSCOPY. 


the  J  inch  objective  the  -j-oVg-  of  an  inch  equals  one  notch 
and  a  half  of  the  cobweb  micrometer,  and  a  salivary  cor- 
puscle occupies  the  space  between  the  threads  when  just 
three-fourths  of  a  notch  (75°)  apart,  simply  multiplying 
1000  by  the  number  of  degrees  required  to  include  ToViF 
of  an  inch  (150°),  and  dividing  the  product  by  the  number 
required  to  include  the  object,  will  give  the  denominator 
of  a  fraction,  whose  numerator  is  1,  expressing  the  diam- 
eter in  parts  of  an  inch  =  ^  oVo  5  the  formula  in  brief  being, 
if  we  represent  the  number  of  degrees  of  the  micrometer 
found  equal  to  ifa-$  of  an  inch  by  #,  the  number  of  de- 
grees equal  to  the  diameter  of  the  object,  with  the  same 
magnifying  power,  by  b,  and  the  denominator  of  the  fraction 
expressing  the  actual  diameter  of  the  object  by  x,  we  have 

1)  :  a  :  :  1000  :  x  or  x=  -  .     If  unprovided  with  an 

o 

eye-piece  micrometer,  you  must  first  have  measured  the  am- 
plifying power  of  the  lens  and  objective  (which  being  once 
known,  you  should  record  on  a  slip  of  paper  pasted  upon 
the  inside  of  the  door  of  your  microscope  box),  and  then 
drawing  the  object  upon  paper  held  on  a  line  with  the 
stage  (or  if  the  camera  is  used,  at  an  equal  distance  from 
the  eye-piece),  measure  its  size,  as  so  delineated,  in  inches 
and  decimal  parts  of  an  inch,  and  divide  this  number  by 
the  number  of  diameters  your  instrument  magnifies,  which 
will  give  its  actual  magnitude  ;  for  example,  if  you  find  a 
salivary  corpuscle,  when  drawn  on  the  paper,  measures 
-fa  of  an  inch  as  magnified  under  your  \  inch  objective  and 
No.  1  eye-piece,  having  a  power  of  200  diameters,  you 
find,  dividing  ^  by  200,  that  the  actual  size  of  the  cor- 
puscle is  2oVo  °f  an  mcn- 

In  determining  the  magnifying  power  of  any  combina- 
tion of  eye-piece  and  objective,  some  standard  is  necessary, 
and  the  stage  micrometer,  ruled  to  y-^  of  an  inch,  is  gen- 
erally employed  ;  this  is  to  be  placed  upon  the  stage,  the 


LVSTR  UMWTS,   A /'/'A  It  AT  I  ?&,   ETC.  (\  \ 

lines  brought  into  focus,  and  a  drawing  made  very  care- 
fully of  them  upon  paper,  held  exactly  on  a  level  with  the 
stage;  the  average  distance  of  the  lines  thus  depicted  is 
then  to  be  measured  with  dividers,  upon  the  scale  of  equal 
parts,  used  in  surveying,  and  the  fraction  of  an  inch,  to 
which  it  is  equivalent  when  multiplied  by  1000,  will  give 
the  magnifying  power  of  the  combination;  thus,  if  the 
drawing  made  of  the  micrometer  lines,  as  seen  through 
the  £  inch  objective  and  No.  1  eye-piece,  represents  these 
one-fifth  of  an  inch  apart,  multiplying  this  fraction  by 
1000,  you  find  200  as  the  magnifying  power  ;  while,  if 
the  same  objective  with  the  No.  2  eye-piece  gives  a  pic- 
ture in  which  the  lines  are  three-tenths  of  an  inch  apart, 
multiplying  this  fraction  by  1000,  you  obtain  300  as  the 
magnifying  power.  It  is  a  fact,  not  generally,  or  at  least 
universally,  known,  that  variations  in  the  adjustment  for 
the  thin  glass  cover  make  important  differences  in  the 
magnif}7ing  power  of  the  lens,  arrangement  for  the  thickest 
cover  giving  the  greatest  amplification.  If  unprovided 
with  a  micrometer,  you  may  prepare  a  standard  accurate 
enough  for  ordinary  purposes  by  passing  a  small  camel's- 
hair  brush,  dipped  in  fresh  human  blood  from  a  healthy 
man,  across  a  slide,  allowing  it  to  dry,  and  then  making  a 
drawing  of  four  of  the  red  corpuscles  (as  magnified)  of 
average  size,  which  have  happened  to  lie  in  a  line  just 
touching,  but  not  overlapping  each  other  ;  seven-eighths  of 
the  sum  of  their  diameters  will  very  nearly  represent  y^o 
of  an  inch,  and  hence  you  can  calculate  the  power  of  that 
particular  eye-piece  and  objective,  according*  to  the  rule 
above  given.  Much  time  may  be  saved  by  ruling  upon 
stiff  cards  lines  representing  thousandths  of  an  inch,  as 
magnified  by  different  lenses  in  various  combinations,  since 
it  is  very  easy  to  approximate  quite  closely  to  the  diam- 
eter of  a  magnified  object  by  holding  the  proper  scalo  on 


02  MEDICAL   MICROSCOPY. 

a  level  with  the  stage  and  projecting  the  image  seen 
through  the  microscope  upon  it,  as  in  drawing. 

The  application  of  reagents  is  to  be  made  in  the  way 
already  directed  for  coloring  the  epithelial  cells  with 
aniline  (p.  45),  except  that  should  the  fluid  have  become 
dry  at  the  edges  of  the  cover  a  small  strip  of  blotting- 
paper,  moistened  at  its  tip,  should  be  placed  at  the  oppo- 
site angle  or  side,  in  order,  by  its  capillary  attraction,  to 
draw  the  test  liquid  beneath  the  thin  glass.  After  a  few 
experiments  with  aniline,  the  student  may  proceed  to  act 
upon  the  leucocytes  of  pus  with  acetic  acid,  and  when 
quite  familiar  with  the  process,  may  endeavor  to  dissolve 
some  oil  globules,  as  those  of  milk,  in  ether,  under  the 
microscope.  While  using  reagents,  it  is  advisable  to  erect 
the  microscope  so  that  the  stage  may  be  in  a  horizontal 
position,  in  order  that  corrosive  fluid  may  not  run  down 
upon  and  injure  the  brass-work  of  the  stand.  The  growing 
slide,  which  is  very  useful  in  subjecting  bodies  to  a  con- 
tinuous current  of  water  or  an  aqueous  solution,  consists 
merely  of  a  common  slide,  upon  one  end  of  which  has 
been  cemented,  by  gold  size  or  other  material,  a  small 
glass  vial  that  can  be  filled  with  water,  and  supply  it 
very  gradually  by  means  of  a  soft  cotton  thread,  to  the 
upper  edge  of  a  cover  placed  upon  it. 

I  have  already  advised  the  student  to  procure  the  assist- 
ance of  some  experienced  microscopist  in  examining  the 
goodness  of  his  lenses,  but  as  this  may  sometimes  be  diffi- 
cult, shall  subjoin  a  few  remarks  upon  such  investigation. 
Epithelial  cells  and  salivary  corpuscles  may  always  be  pro- 
cured as  described  above  (p.  45),  and,  in  addition  to  these, 
the  dark  and  light  scales  of  the  Podura(to  be  had,  mounted, 
of  most  opticians)  are  excellent  test  objects;  the  dots  upon 
the  cells  should  be  shown  sharp,  clear,  and  distinct,  as  those 
in  Fig.  4,  or  even  as  in  a  fine  steel  engraving,  with  the 
No.  1  eye-piece,  and,  in  a  general  way,  the  deeper  the  eye- 


INSTRUMENTS,  APPARATUS,  ETC.  <;;; 

piece  with  which  their  outlines  continue  to  present  this 
character,  the  more  perfect  is  the  lens.  The  able  edit- 
ors of  the  Micrographic  Dictionary  recommend,  among 
others,  the  following  as  test  objects  of  the  different 
powers:  "For  the  1  inch  or  §  inch  object-glass;  magni- 
fying power  60  diameters ;  angular  aperture  22°  to  35°. 
Hair  of  the  dermcstes"  (larva  of  D.  lardarinus,  or  bacon 
beetle),  "  of  the  bat,  the  pygidium  of  the  flea,  the  outline  of 
the  areoloe  being  distinguishable  under  the  high  eye-piece 
(120  to  200  diameters),  but  not  the  rays.  Also  an  injec- 
tion, as  a  piece  of  lung.  £  inch  object-glass;  magnifying 
power  220  diameters;  angular  aperture  75°  to  140°. 
Tests — hair  of  dermestes ;  the  discs  of  deal;  the  salivary 
corpuscles,  the  moving  molecules  being  clearly  distinguish- 
able ;  the  smaller  scales  of  Lepisma"  (L.  saccharina,  or 
silver  fish,  found  on  old  books,  etc.),  "the  scales  of  Podura; 
the  filaments  of  Didymohelix;  the  pygidium"  (the  ninth 
and  last  segment  in  the  abdomen  of  the  female)  "  of  the 
flea ;  and  the  scales  of  Pontia  brassicae.  ^  inch  object- 
glass;  magnifying  power  420  to  450  diameters;  angular 
aperture  110°  to  150°.  Tests — the  paler  scales  of  the 
Podura;  the  pygidium  of  the  flea;  the  scales  of  Pontia 
brassier ;  the  filaments  of  Didymohelix,  showing  the 
component  fibres;  the  salivary  corpuscles."  As  tests  of 
definition  and  angular  aperture,  the  valves  of  some  Di- 
atoms, such  as  the  Pleurosigma  angulatum,  and  the  Suri- 
rella  gemma,  may  be  resorted  to  for  tests  of  the  high  powers, 
— that  is,  those  above  J  inch.  Nobert's  test  plate  is  com- 
posed of  a  series  of  bands  of  fine  lines  ruled  very  closely 
together  by  some  process  kept  secret  by  the  operator. 
Lieut.-Colonel  Woodward  has  recently  succeeded  in  re- 
solving the  lines  in  the  nineteenth  band,  which  number 
57,  or  114,000  to  the  inch.  (See  American  Journal  of  Sci- 
ence and  Arts,  Sept.  1869.)  In  a  paper  read  before  the 
Royal  Microscopical  Society  of  London,  October  13th,  1869 


G4  MEDICAL  MICROSCOPY. 

(Quarterly  Journal  of  Microscopical  ^ Science,  Jan.  1870, 
p.  94),  Dr.  Woodward  states  that,  while  the  immersion 
Tag  of  Powell  &  Lealand  resolved  the  nineteenth  band, 
their  ^  and  -1$  and  an  J  of  Wales,  all  dry  lenses,  re- 
solved the  fifteenth  band,  but  not  the  sixteenth;  an  immer- 
sion jig-  by  Wales  resolved  the  sixteenth  band,  but  failed 
to  go  further ;  an  immersion  -^  by  Wales  and  a  Hartnack 
immersion  No.  11  resolved  the  seventeenth  band,  but  failed 
to  go  further. 

In  adjusting  an  objective  for  the  thin  glass  cover  of  an 
object,  Dr.  Beale  directs  to  arrange  the  lenses  so  as  to 
give  the  best  definition  of  an  uncovered  object;  then  focus 
some  object  covered  with  the  thin  glass,  and,  without 
moving  the  body  of  the  microscope,  turn  the  screw  collar 
until  any  particles  of  dust  on  the  upper  surface  of  the 
cover  come  into  view,  when  the  required  correction  is  ac- 
complished; or  the  adjustment  may  be  made  by  repeated 
trials  with  the  screw  collar  of  the  objective  at  different 
points,  carefully  observing  with  which  the  clearest  image 
of  the  object  is  obtained. 

For  testing  the  definition  of  high  powers,  such  as  the 
iV  2T»  and  TQ  of  an  inch  objectives,  Dr.  Royston  Pigott, 
in  the  Quarterly  Journal  of  Microscopical  Science  for 
January,  1870,  maintains  that  the  markings  of  the  Po- 
dura  scale  (which  he  calls  spectral)  so  generally  employed 
by  opticians  as  a  guide  by  which  the  accurate  "correction" 
of  their  objectives  may  be  determined,  are  unreliable  as  a 
standard,  the  appearance  of  dots  like  notes  of  exclamation 
(!!)  being  "absolutely  false  and  delusive."  Instead  of 
the  scales  of  the  Podura  he  recommends  the  use  of  very 
reduced  images  of  objects,  such  as  a  globule  of  mercury, 
the  face  of  a  watch,  etc.,  formed  by  a  pair  of  minute  lenses 
arranged  beneath  the  stage  (somewhat  in  the  manner  of 
an  achromatic  condenser),  as  tests  of  definition.  In  de- 
fault of  these,  he  advises  the  valves  of  certain  Diatoms, 


INSTRUMENTS,  A /'/'A  AM  TUS,  ETC.  65 

especially  Pleurosigma  formosum,  and  mentions  one  test 
which  is  readily  obtainable  by  all,  as  follows:  "  A  severe 
test  is  the  appearance  of  minute  hairs,  30^-5-5  of  an  inch 
in  diameter.  A  fine  definition  shows  a  hair  to  bear  two 
black  borders  and  a  central  line  of  light,  with  scarcely  any 
penumbra  (or  shadowy  outline),  under  the  ^e  and  immer- 
sion lens.  Hairs  of  antennae  of  male  gnat  were  employed." 
For  further  information  upon  the  subject,  and  also  for  a 
simple  formula  for  calculating  the  magnifying  powers  of 
objectives  combined  with  different  eye-pieces,  my  readers 
are  referred  to  the  original  paper. 

As  an  economical  means  for  increasing  the  power  of  an 
objective,  the  Amplifier  (such  as  is  used  in  the  telescope) 
has  lately  been  adapted  by  some  of  our  American  opticians. 
It  consists  of  an  achromatic  plano-concave  lens,  mounted 
in  a  short  brass  tube,  which  slides  into  the  lower  extremity 
of  the  draw-tube  (see  page  20),  so  that  the  observer  is 
enabled  to  arrange  it  at  a  suitable  distance  between  the 
object-glass  and  the  inner  combination  of  the  eye-piece. 
It  will,  as  I  am  informed  by  my  friend,  Dr.  J.  Gibbons 
Hunt,  when  properly  adjusted  to  any  objective,  double  its 
power,  at  the  same  time  it  increases  its  working  distance, 
without  that  decrease  of  light  and  loss  of  definition  inevi- 
table when  a  corresponding  gain  in  amplification  is  obtained 
by  the  use  of  a  deeper  eye-piece. 

Amplifiers  may  be  had  of  Messrs.  Tolles,  Grunow  & 
Zentmayer  at  prices  varying  from  three  to  twelve  dollars. 

Some  very  beautiful  and  brilliant  results  may  be  ob- 
tained by  using  polarized  light  for  the  illumination  of  cer- 
tain objects,  as,  for  example,  a  minute  crystal  of  naphtha- 
line ;  but,  as  far  as^I  am  aware,  this  method  possesses  no 
great  practical  value,  and,  according  to  Dr.  Beale,  its  ad- 
vantages have  been  greatly  overrated.  Polarization  of  the 
light  is  generally  effected  by  passing  it  through  two  crys- 
tals of  Iceland  spar  (one  adjusted  in  its  brass  setting 


GO  MEDICAL   MICROSCOPY. 

beneath  the  stage,  and  called  the  polarizer ;  the  other  ar- 
ranged above  the  eye-piece,  and  named  the  analyzer) ; 
but  tourmaline  or  the  iodosulphate  of  quinine  may  be 
employed. 

The  use  of  the  spectrum  microscope,  full  of  promise  as 
it  is  for  the  future,  has  not  as  yet  been  sufficiently  studied 
to  render  its  detailed  explanation  necessary  here.  For 
this  my  readers  are  referred  to  the  excellent  chapter  upon 
the  subject  by  Mr.  H.  C.  Sorby,  in  Dr.  Beale's  "  How  to 
Work  with  the  Microscope,"  fourth  edition,  p.  218  et  seq. 

The  high  degree  of  perfection  recently  attained  in  pho- 
tographing microscopic  objects  by  Col.  J.  J.  Woodward, 
M.D.,  Assistant  Surgeon  U.  S.  Army,  to  whom  I  am 
deeply  indebted  for  a  copy  of  his  admirable  "  Report  on 
the  Magnesium  and  Electric  Lights  as  applied  to  Photo- 
Micrography"  (War  Department,  Surgeon-General's  Office, 
Washington,  D.  0.,  Jan.  5,  1870),  and  its  accompanying 
specimens  of  the  art,  should  stimulate  others  to  pursue 
his  footsteps  and  to  emulate  (if  possible,  equal)  these  pro- 
ductions of  our  Army  Medical  Museum,  which  have  hith- 
erto surpassed  those  of  microscopists  throughout  the 
world.  (See  a  reprint  of  the  report  in  the  American 
Journal  of  Science  and  Arts,  May,  1870,  p.  294.) 


CHAPTER   III. 

EXAMINATION    OF    URINE. 

Division  1.— Light  or  Flocculent  Deposits. 
SECTION  A. — Casts  of  the  Uriniferous  Tubules — Bright's  Disease. 

IN  order  to  simplify  as  far  as  possible  the  subject  of  the 
microscopic  examination  of  the  urine,  which,  of  course, 
forms  a  large  and  important  part  of  the  work  clone  by  the 
rnicroscopist,  I  have  adopted,  with  some  modifications,  the 
arrangement  employed  by  Prof.  Lionel  Beale,  in  his  in- 
valuable work  on  Kidney  Diseases  and  Urinary  Deposits, 
as  being  best  suited  to  the  wants  of  most  who  will  refer 
to  these  pages,  by  exhibiting  at  a  glance  what  portion  of 
the  volume  must  be  consulted  in  order  to  find  information 
respecting  the  particular  sample  of  urine  they  wish  to 
examine. 

Let  us  suppose  that  a  specimen  of  urine  is  offered  for 
investigation  (some  history  of  the  patient  being  also  sup- 
plied, as  should  always  be  the  case)  ;  when  possible,  it  is 
generally  best  to  direct  that  four  fluidounces  of  that 
passed  on  awaking  in  the  morning  after  a  night's  sleep 
should  be  emptied  from  a  clean  vessel  into  a  bottle  that 
has  just  been  thoroughly  washed  with  fresh  water,  which 
should  be  stopped  with  a  new  cork,  and  brought  to  the 
physician's  office  within  three  hours  from  the  time  it  was 
voided ;  nor  is  this  an  excess  of  precaution,  as  many  who 
have  been  puzzled  and  misled  by  some  accidental  im- 
purity occurring  in  the  fluid  will,  I  think,  admit  without 
question. 

* 


68  MEDICAL  MICROSCOPY. 

On  its  reception,  the  urine  should  be  poured  into  a 
conical  glass,  of  about  five  ounces  capacity,  carefully  cov- 
ered with  a  piece  of  cardboard  to  exclude  dust,  and  set 
aside  where  it  will  be  undisturbed,  for  about  twelve  hours  ; 
at  the  end  of  this  period,  any  existing  sediment,  which  is 
likely  to  be  let  fall  at  all,  will  have  subsided,  and  a 
moment's  glance  will  decide  whether  such  deposit  is 
Scanty,  granular,  or  crystalline,  in  which  case  consult 
Chapter  VI.,  Dense  and  bulky,  when  it  will  be  found  de- 
scribed in  Chapter  V.,  or  Light  and  flocculent,  which 
brings  it  in  the  present  division.  In  order  to  determine 
whether  it  belongs  to  Section  A.  or  B.,  however,  the  urine 
should  be  tested  for  albumen  in  the  usual  way,  by  boiling 
a  couple  of  fluidrachms  in  a  test-tube,  and  also  by  the 
addition  of  a  few  drops  of  nitric  acid,  when,  if  no  pre- 
cipitate, or  even  the  slightest  cloudiness,' is  produced, 
the  sediment  probably  consists  of  mucus,  spermatozoa, 
vibriones,  or  bacteria,  as  pointed  out  in  Chapter  IV., 
while,  if  an  albuminous  coagulum  is  formed  by  the  re- 
agents above  mentioned,  tube-casts,  such  as  I  am  about 
to  describe,  will  generally  be  found.* 

Presuming  now  that  a  deposit  has  been  let  fall  to  the 
bottom  of  the  conical  vessel  containing  this  albuminous 
urine,  a  glass  tube  pipette,  of  suitable  length,  is  selected, 
the  larger  opening  firmly  closed  by  the  forefinger,  and  the 
tapering  extremity  carried  down  to  the  very  bottom  of  the 
glass,  beneath,  or  at  least  in  contact  with  the  layer  of  sedi- 
ment there  formed.  The  pressure  of  the  finger  at  the  upper 
opening  of  the  tube  is  then  slightly  relaxed,  and  a  small 
quantity  of  the  urine,  with  some  of  the  deposit  in  suspen- 

*  I  have  seen  a  few  cases  in  which  extremely  delicate  Hyaline 
casts  were  visible  in  sediment  from  non-albuminous  urine,  but  so 
difficult  were  they  of  detection  that  it  seems  to  me  only  an  ex- 
perienced microscopist,  working  with  a  superior  objective,  could 
be  blamed  for  not  discovering  them. 


URINE—  BRIGHT^  DISEASE.  69 

sion  allowed  to  enter  our  tube  until  about  one  inch  of  its 
caliber  is  filled,  when  the  superior  aperture  is  to  be  tightly 
closed  as  before,  the  tube  withdrawn,  about  half  of  its 
contents  allowed  to  flow  out,  and  the  external  surface 
wiped  off  with  a  piece  of  new  muslin  or  linen. 

A  glass  slide  and  cover  having  been  previously  pre- 
pared, as  described  in  Chapter  II.  (p.  34),  the  pipette,  still 
closed  at  its  upper  end  by  the  forefinger,  is  brought  in  con- 
tact with  the  middle  of  the  slide,  and  the  finger  raised 
slightly  so  as  to  permit  the  exit  of  a  single  drop  of  its  con- 
tents, which  is  immediately  covered  with  the  square  of  thin 
glass,  and  any  excess  of  urine  which  may  exude  at  the 
margin  of  this  cover,  removed  by  bringing  in  contact  with 
it  the  ragged  edge  of  an  old  piece  of  muslin,  when  it  will 
be  quickly  absorbed  ;  great  care  must  be  taken  not  to  push 
the  cover  upon  the  stratum  of  urine  between  it  and  the 
slide,  as  a  very  slight  movement  of  this  kind  will  greatly 
modify  the  microscopic  appearances.  I  have  seen  at  least 
a  thousand  collections  of  blood  corpuscles  so  aggregated 
together  into  cylindrical  masses  as  to  accurately  imitate 
the  tube-casts  of  Bright's  disease,  all  produced  in  a  moment 
by  neglect  of  this  precaution. 

The  specimen  is  now  ready  for  examination,  and  is 
therefore  placed  upon  the  stage  of  the  microscope,  a  mod- 
erate light  thrown  upon  it  from  beneath  by  the  mirror ; 
and  the  objective,  which  should  be  a  quarter,  one-fifth,  or 
one-eighth  inch  (giving  a  power  of  from  200  to  400  diam- 
eters), brought  to  its  proper  focal  distance  above  it,  as  de- 
scribed in  Chapter  II.  under  the  head  of  Manipulations. 
(See  page  46  et  seq.).  In  order  that  a  thorough  examination 
of  the  contents  of  the  drop  may  be  made,  it  is  well  to  con- 
duct the  investigation  systematically  from  a  certain  point, 
as  for  example  the  upper  right-hand  corner  of  a  thin  glass 
cover,  half  an  inch  square,  moving  the  stage  in  a  horizontal 

7 


70 


MEDICAL   MICROSCOPY. 


direction  until  the  upper  left-hand  corner  comes  into  view 
(or  as  far  in  that  course  as  the  adjustment  of  the  stage 
will  permit),  then  raising  the  stage  in  a  vertical  direction, 
the  width  of  a  single  field,  reversing  its  former  horizontal 
motion  until  the  right  border  is  again  reached,  and  so 
proceeding  like  a  farmer  plowing  backward  and  forward 
across  his  field  until  no  portion  has  been  neglected,  or  until 
the  observer  is  quite  satisfied  in  regard  to  the  nature  of 
the  deposit. 

FIG.  5. 


b.  c.  d.  e.  f.       g. 

TUBE-CASTS  OF  BRIGHT'S  DISEASE.    X  220  DIAMETERS. 

a.  Fragment  of  linen  fiber,  resembling  a  tube-east  in  size  and  shape,  6.  Large 
hyaline  cast.  c.  Small  pale  granular  cast.  d.  Very  small  granular  cast.  e. 
Medium-sized  dark  granular  cast.  /.  Epithelial  cell,  showing  oil  globules  of  fatty 
degeneration,  g.  Fatty  epithelial  cast. 

I  well  remember,  when  a  mere  tyro  in  the  art  of  micro- 
scopy, consulting  an  intimate  friend  somewhat  further 
advanced,  but  also  in  the  stage  of  pupilage,  in  regard  to  a 
supposed  cast  from  a  uriniferous  tubule  occurring  in  the 
urine  of  a  patient  believed  to  be  suffering  from  Bright's 
disease,  the  nature  of  which  we  could  neither  of  us  satis- 


mixr.— ni;ra  urs  />/SKAS/-:.  71 

factorily  determine,  although  now,  looking  back  to  its  ap- 
pearance. I  am  confident  that  it  was  ncit  her  more  nor  less 
than  a  minute  filament  of  flax  derived  from  the  soft  linen 
rag  with  which  I  had  cleaned  the  slide;  and,  in  order  to 
prevent  others  from  being  led  into  like  uncertainty,  I  have 
introduced  into  the  accompanying  figure  at  a,  the  camera 
lucida  drawing  of  a  similar  linen  fiber,  at  the  same  time 
contrasting  it  with  some  well-marked  tube-casts.  In  this 
particular  instance  the  error  would  have  been  an  egregious 
one  for  any  but  a  student;  but  cases  often  occur  when  the 
detection  of  true  casts  is  by  no  means  easy,  and  some- 
times only  a  very  extended  experience  will  enable  the 
microscopist  to  recognize  them. 

In  diagnosticating  veritable  tube-casts  in  the  urine,  I 
believe  that  the  discovery  of  epithelial  cells  from  the 
uriniferous  tubules  imbedded  or  firmly  attached  to  the 
cast,  as  shown  in  the  figure  at  y,  is  the  most  certain  indi- 
cation ;  of  course,  many  casts  occur  without  any  epithelial 
cells,  but,  except  in  the  last  stages  of  albuminuria,  when  the 
tubules  seem  to  be  quite  denuded  of  their  cellular  lining, 
I  think  it  is  rare  to  examine  a  whole  slide  charged  with 
tube-casts  (as  above  directed)  without  finding  at  least  one 
or  two  exhibiting  well-defined  epithelium.  The  mistake 
of  deeming  that  a  cell  which  simply  overlies  a  cast  is 
imbedded  in  it,  may  be  guarded  against  by  setting  up  a  to- 
and-fro  current  in  the  liquid  by  gentle  taps  with  a  mounted 
needle  upon  the  cover,  and  so  separating  the  two  objects, 
if  no  union  between  them  exists.  Another  important  in- 
dication is  the  detection  of  red  blood  disks  and  white  blood 
globules  (mucous,  pus,  or  exudation  corpuscles)  attached 
to  the  casts  (see  Fig.  6),  and  although  this  criterion  is 
liable  to  the  same  fallacy  of  being  confounded  with  mere 
juxtaposition  of  the  two  elements,  testing  it  as  above  sug- 
gested will  generally  prevent  mistakes. 

The  size  of  a  suspected  cast  will  often  give  great  assist- 


72  MEDICAL  MICROSCOPY. 

ance  in  satisfying  one's  self  in  regard  to  its  nature,  for 
although  true  casts  ordinarily  vary  from  the  y^1^  to  -5^ 
of  an  inch  across,  yet  in  my  experience  the  cases  where  a 
diagnosis  is  difficult  are  those  in  which  the  casts  are  of 
rather  small  diameter, — not  exceeding  the  -j^Vo"  of  an  inch 
in  thickness,  and  appearing,  under  a  power  of  200,  about 
the  size  of  those  drawn  at  c  and  d,  in  Fig.  5 ;  because 
when  the  disease  has  advanced  so  far  as  to  strip  many  of 
the  tubules  of  their  epithelial  lining,  and  so  allow  large  and 
medium-sized  casts  to  be  formed,  a  well-marked  albuminous 
coagulum  is  generally  obtained  on  testing  the  urine  with 
heat  and  nitric  acid,  and  the  condition  of  the  patient  (with- 
out being  acquainted  with  which  no  physician  should  give 
a  positive  opinion)  is  usually  such  as  to  throw  a  great 
deal  of  light  upon  the  subject,  and  prevent  erroneous  con- 
clusions. 

The  rounded  or  club-shaped  form  of  an  extremity,  as 
delineated  at  e  and  g,  in  Fig.  5,  has  often  aided  me  in  de- 
termining that  some  little  aggregation  of  matter  was  a 
veritable  tube-cast,  since  I  have  very  rarely  seen  it  occur, 
except  in  cases  where  other  examinations  showed  casts 
containing  epithelial  cells,  and  rendered  the  diagnosis  cer- 
tain ;  such  an  appearance,  however,  is  by  no  means  a  con- 
stant .character,  and  its  absence,  therefore,  must  not  be 
taken  as  disproving  the  existence  of  Bright's  disease. 

The  test  by  pressure  upon  the  cover,  as  described  in 
Chapter  VII.,  is  also  frequently  valuable  in  a  diagnostic 
point  of  view.  When  the  casts  are  very  delicate  and 
hyaline  they  may  often  be  seen  more  distinctly  if  looked 
for  with  the  field  of  view  but  feebly  illuminated  and  just 
outside  the  exact  focus  of  the  lens,  a  position  obtained  by 
adjusting  the  body  of  the  microscope  so  as  to  give  the 
sharpest  definition  of  some  object  on  the  slide,  as  a  cell  of 
vesical  epithelium  or  the  edge  of  an  air  bubble,  then  rais- 
ing the  body  by  perhaps  the  tenth  part  of  a  turn  of  the 


URINE—  BRIO/IT'S    DISK  AS/-:.  7;; 

line  adjustment  screw  and  proceeding  with  the  examina- 
tion. This  method  is  particularly  applicable  to  the  detec- 
tion of  so-called  waxy  hyaline  casts,  which,  by  their 
greater  refractive  power,  so  concentrate  the  light  as  to 
become  much  more  clearly  visible. 

As  has  been  intimated  above,  the  student  who  fails  to 
discover  tube-casts  in  the  first  few  fields,  should  not  at 
once  conclude  that  none  exist  in  the  urine,  but  must 
patiently  persevere  in  examining  field  after  field,  and,  if 
necessary,  slide  after  slide,  varying  the  amount  and  direc- 
tion of  the  illumination  and  the  adjustment  of  the  focus 
until  he  is  sure  that  no  bodies  resembling  any  of  those 
delineated  as  casts  in  Fig.  5  are  visible  ;  he  should  also 
consult  and  compare  any  doubtful  aggregation  of  matter 
which  he  may  meet,  with  other  drawings  in  this  volume, 
and  also  with  plates  of  microscopic  appearances,  given  in 
the  text-books  of  medicine  he  may  possess,*  not  allowing 
himself  to  be  discouraged  by  the  difficulties  which  waylay 
him,  nor  by  a  temporary  want  of  success,  but  remembering 
that  the  old  maxim,  Perseverentia  OMNIA  vincit,  is  no- 
where more  literally  true  than  among  the  obstacles  of 
microscopy.  I  have  often,  as  in  the  case  of  X.  Y.  detailed 
on  p.  78,  spent  hours  over  a  single  specimen  of  urine,  slowly 
and  carefully  examining  a  whole  slide,  composed  of  more 
than  a  hundred  fields,  without  being  rewarded  by  the  dis- 
covery of  a  single  indubitable  cast,  and  yet  in  the  end 
accumulating  evidence  sufficient  to  accurately  diagnosticate 
the  disease. 

If  the  most  careful  examination,  while  failing  to  reveal 
tube-casts,  discloses  red  or  white  blood  (pus)  corpuscles,  it 


*  As  Watson's  Practice  of  Medicine,  Da  Costa's  Medical  Diag- 
nosis, Bennett's  Clinical  Medicine,  Koberts  or  Bird  on  the  Urine, 
Grainger  Stewart  on  Bright's  Diseases,  etc.  » 

7* 


74  MEDICAL  MICROSCOPY. 

is  probable  the  urine  is  albuminous  from  admixture  of 
serum,  from  hemorrhage,  or  from  the  formation  of  pus,  as 
described  in  Chapter  VI.,  which  see. 

Assuming  now  that  the  investigation,  whose  steps  I 
have  been  endeavoring  to  point  out  with  a  minuteness 
which  I  fear  will  seem  tedious  to  some  of  my  readers,  has, 
unfortunately  for  the  hypothetical  patient,  resulted  in  the 
detection  of  well-defined  casts,  it  becomes  further  an  im- 
portant subject  of  inquiry  with  what  form  and  stage  of 
Bright's  disease  we  have  to  deal ;  a  question  which  may 
generally  be  answered  by  a  careful  and  comprehensive 
examination  of  the  kind,  number,  and  magnitude  of  the 
casts,  the  characters  and  abundance  of  the  associated 
epithelial  cells  and  blood  corpuscles,  and  of  the  signs 
and  symptoms  as  well  as  the -previous  history  of  the 
disease. 

Recognizing,  then,  the  superiority  of  the  classification  of 
Dr.  Grainger  Stewart,*  on  the  basis  of  Virchow,  for  pur- 
poses of  scientific  study,  I  propose  to  vary  somewhat  the 
mode  of  arrangement  adopted  by  these  high  authorities,  in 
such  a  manner  as  to  bring  more  prominently  into  view  the 
microscopic  appearances  of  the  urine  as  leading  indications 
for  the  diagnosis  of  the  different  forms  and  stages  of  albu- 
minuria,  premising,  however,  that  the  rules  which  I  am 
able  to  give  are  subject  to  numerous  exceptions,  and  must 
only  be  made  use  of  as  approximative  indices,  and  not  as 
infallible  guides  to  a  perfectly  accurate  judgment ;  for  just 
as  with  the  stethoscope  and  the  clinical  thermometer, 
unless  particular  signs  are  carefully  read  by  the  light  of 
general  symptoms,  both  past  and  present,  the  physician 
will  constantly  be  liable  to  fall  into  error. 

It  must  be  remembered,  too,  that  owing  to  the  fact  that 
renal  disease,  whether  inflammatory,  amyloid,  or  cirrho- 

*  Bright's  Diseases  of  the  Kidneys,  p.  8. 


URINE—  HRiairrs  DISK  AS/-:.  75 


tic,  usually  exists,  when  it  does  occur,  in  varying  du^ 
in  different  kidneys  or  in  different  parts  of  the  same  organ, 
the  casts  which  are  found  therefore  legitimately  lead  us 
to  the  conclusion  that  various  stages  of  the  disease  coexist 
in  the  same  patient  ;  if,  however,  two  or  three  specimens 
of  the  urine  be  examined,  and  the  number  of  each  variety 
of  casts  noted,  a  very  satisfactory  conclusion  can  mostly 
be  reached  as  to  the  general  or  average  condition  of  the 
renal  organs. 

In  order  to  aid  the  student  in  deriving  from  the  history 
of  the  case  all  the  assistance  toward  forming  an  accurate 
diagnosis  which  it  is  able  to  afford,  I  will  here  endeavor 
to  group  together  some  of  the  more  prominent  symptoms 
which  should  direct  our  attention  especially  to  a  par- 
ticular form  of  albuminuria  ;  condensing,  for  this  purpose, 
some  of  the  admirable  descriptions  of  Dr.  Grainger 
Stewart. 

The  first  or  Inflammatory  form  of  Bright's  disease, 
which  may  be  of  long  or  short  duration,  according  as  it  is 
more  or  less  chronic  in  its  character,  generally  comes  on 
after  exposure  to  cold  or  wet,  or  after  some  febrile  affec- 
tion, and  is  indicated  by  pain  in  the  back,  scanty  but  fre- 
quent micturition,  the  urine  being  dark,  bloody,  or  smoky 
(if  acid),  highly  albuminous,  and  depositing  numerous  tube- 
casts.  The  face,  legs,  or  scrotum  become  oedematous, 
which  oedema  may  rapidly  extend.  There  is  often  fever, 
dyspnoea,  and  headache  or  drowsiness.  Should  treat- 
ment, in  such  cases,  be  neglected,  or  prove  unavailing, 
the  dropsy  may  increase  and  produce  death  by  mechanical 
interference  with  the  action  of  the  lungs  and  heart,  or  the 
poisoned  blood  may  so  affect  the  brain  that  uraemic  con- 
vulsions or  coma  lead  the  way  to  a  fatal  result.  When,  as 
frequently  happens,  Bright's  disease  exists  as  a  complica- 
tion of  some  more  serious  affection,  death  sometimes  oc- 
curs before  dropsy  is  developed  or  makes  much  progress. 


7(5  MEDICAL  MICROSCOPY. 

In  more  favorable  cases,  however,  the  symptoms  gradu- 
ally abate,  as  in  the  following  example,  which  I  quote 
from  my  paper  "  On  the  Diagnostic  Yalue  of  the  Corpus- 
cular Blood  Elements  in  the  Urine,"  in  the  Am.  Jour,  of 
Med.  Sci.  for  January,  1870  : 

"  CASE  IY. — Exemplifies  that  frequent  occurrence  in 
the  course  of  Bright's  disease,  an  acute  attack  superven- 
ing upon  one  of  the  chronic  forms,  as  follows : 

"Ellen  G.,  cloakmaker,  aet.  29,  unmarried,  was  admitted 
into  the  Women's  Medical  Ward  of  the  Pennsylvania 
Hospital,  May  2d,  1869,  during  the  service  of  Prof.  J. 
Aitken  Meigs,  who  has  kindly  permitted  me  to  report  the 
case.  The  patient  stated  that  her  father  died  of  consump- 
tion twenty-six  years  before,  and  her  brother  of  dropsy  in 
his  twenty-second  year.  She  had  worked  very  hard  at 
her  trade  for  the  last  ten  years,  sometimes  as  much  as 
fifteen  hours  daily,  and  during  that  time — nearly  eight 
years  since — had  a  severe  attack  of  yellow  fever,  subse- 
quent to  which  she  had  suffered  much  from  dyspepsia, 
and  been  troubled  occasionally  with  eruptions  upon  the 
face.  About  five  weeks  before  admission  she  took  a  very 
severe  cold,  after  exposure  to  wet,  which  was  followed  by 
a  sense  of  weakness  in  the  loins  that  gradually  developed 
into  a  sharp  pain  in  the  lumbar  and  abdominal  regions  ; 
nausea  and  vomiting,  loss  of  appetite,  and  intense  thirst 
came  on  about  the  same  time.  One  week  later  she  first 
noticed  puffiness  of  the  eyelids;  and  a  few  days  after- 
ward the  enlargement  of  the  abdomen  and  oedema  of  the 
feet  and  legs-*came  on.  Shortly  after  taking  cold  she 
noticed  that  she  was  obliged  to  rise  three  or  four  times  in 
the  night  to  pass  water :  also  that  the  fluid  when  voided 
was  dusky,  and  deposited,  on  standing,  a  sediment  that 
looked  like  coffee-grounds.  For  the  week  following  her 
exposure  she  had  a  troublesome  diarrhoea,  but  since  then 
her  bowels  have  been  regular,  although  severe  griping 


URINE—  BRIGHT^  DISEASI'.  77 

pains  in  the  abdomen  still  persisted.  Throughout  the  \vn-k 
previous  to  admission  she  had  been  troubled  with  roaring 
noises  in  the  head,  but  she  did  not  suffer  much  from  head- 
ache, and  her  intellect  was  quite  clear.  On  entering  the 
hospital  her  face,  feet,  limbs,  and  abdomen  were  all  very 
cedematous,  and  her  countenance  presented  the  pale,  waxy 
hue  of  Bright's  disease  in  a  very  marked  degree.  A  speci- 
men of  her  urine,  examined  on  the  24th  of  May,  was  of  a 
dark,  reddish-brown  color,  specific  gravity  1010,  and  con- 
tained about  one-third  of  its  bulk  of  albumen  as  coagulated 
by  heat  and  nitric  acid.  Under  the  microscope  I  found  the 
abundant  deposit  let  fall  on  standing  was  composed  of 
large  numbers  of  red  and  white  blood  corpuscles  in  the 
estimated  proportion  of  twenty-five  to  one,  much  granular 
debris,  and  some  well-defined  casts,  granular,  fatty,  and 
fibrinous,  all  more  or  less  stained  with  the  haematin  from 
the  decolorized  red  globules ;  some  of  the  tube-casts  had 
imbedded  in  their  substance  epithelial  cells  which  had 
undergone  marked  fatty  degeneration,  many  of  the  oil 
globules  measuring  Yirinnr  °f  an  ^nc^  m  diameter.  Under 
the  influence  of  appropriate  saline  diuretics  the  flow  of 
urine  rapidly  increased,  and  five  days  after  the  above  ex- 
amination was  made  the  amount  passed  in  the  preceding 
twenty-four  hours  measured  112  fluidounces,  which  free 
diuresis  soon  produced  a  very  satisfactory  decrease  in  the 
anasarca  and  ascites;  but  I  was  unfortunately  prevented 
by  illness  from  making  further  examination  of  this  patient, 
and  can  only  add  that  she  was  discharged  from  the  hospi- 
tal on  the  7th  of  August  very  much  relieved." 

In  some  instances  a  slight  amount  of  disease  in  the 
kidneys  persists  for  months,  giving  rise  to  the  formation 
of  delicate  hyaline  casts,  having  white  blood  corpuscles 
imbedded  in  them,  as  in  the  following  example  also  quoted 
from  the  same  article  : 

"  CASE  VI. — X.  Y.,  merchant,  native  of  Philadelphia, 


78  MEDICAL   MICROSCOPY. 

but  for  some  time  past  residing  in  one  of  the  New  Eng- 
land States,  came  under  my  observation  August  8th, 
1869.  From  his  family  medical  attendant  I  learned  that 
about  six  weeks  before,  he  had  been  exposed  to  cold  and 
wet,  which,  acting  upon  a  constitution  enfeebled  by  the 
poisonous  effect  of  lead  and  various  other  causes  not  neces- 
sary to  mention  here,  had  resulted  in  an  ill-defined  febrile 
attack,  attended  with  pain  in  the  back,  and  high-colored 
urine;  but  that  unfortunately  from  the  fact  of  the  physi- 
cian himself  being  at  the  time  an  invalid,  no  examination 
of  the  renal  secretion  was  then  made.  During  the  first 
week  in  August  he  was  seen  in  consultation  by  Prof. 
Alonzo  Clark,  of  New  York,  who,  on  testing  the  urine, 
discovered,  as  I  was  informed,  a  notable  amount  of  albu- 
men and  several  delicate  hyaline  casts  of  the  uriniferous 
tubules.  My  first  examination  of  the  morning  urine,  made 
during  the  evening  of  August  9th,  with  the  precautions 
above  described,  showed  in  three-quarters  of  a  square  inch 
of  urinous  film  twenty-five  or  thirty  epithelial  cells,  some 
of  which  inclosed  very  minute  oil  globules,  about  an  equal 
number  of  free  white  corpuscles,  and  some  exceedingly 
delicate  hyaline  casts,  two  of  which  contained  one  or  more 
leucocytes  ;  no  red  blood  globules  were  detected ;  on  test- 
ing with  heat  and  nitric  acid  only  a  moderate  opalescence 
of  the  liquid  was  produced,  but  this  trace  was  deposited 
next  day  into  a  thin  film  upon  the  bottom  of  the  tube, 
which  proved  entirely  amorphous  under  the  microscope. 
Frequent  examinations  of  the  urine  from  this  patient  were 
made  with  similar  results,  except  that  the  amount  of 
albumen  gradually  decreased  until  on  the  27th  of  August 
my  note-book  states  that  the  urine  was  clear  and  normal 
in  both  color  and  quantity,  and  on  testing  with  nitric  acid 
not  the  slightest  cloud  was  visible,  nor  was  any  produced 
by  long  boiling  of  the  acidulated  liquid.  Four  fluidounces 
set  aside 'in  a  conical  glass  for  two  hours  let  fall  a  scanty 


URINE—  BR I  GUT  S  1)  I  >  / '  1 S  / '.  7  0 

flocculent  deposit,  which,  under  the  microscope,  was  seen 
to  be  composed  chiefly  of  epithelial  cells  and  white  blood 
corpuscles,  but  also  contained  a  few  very  delicate  hyaline 
casts.  Three-quarters  of  a  square  inch  of  urinous  film 
when  carefully  examined  showed  three  transparent  casts, 
one  of  which  contained  four  white  blood  cells  (pus  cor- 
puscles). On  the  10th  of  September  the  urine  was  found 
free  from  all  traces  of  albumen,  and  in  half  a  square  inch 
of  urinous  film  I  could  only  discover  two  hyaline  casts,  the 
longer  containing  two  epithelial  cells  apparently  healthy, 
and  three  leucocytes,  the  shorter  no  epithelium,  and  but 
one  white  blood  corpuscle. 

"  Except  during  the  first  two  weeks  after  I  began  to  in- 
vestigate his  case,  this  patient  had  no  symptom  of  renal 
disease,  save  the  constant,  although  scanty,  deposit  of  casts, 
white  blood  corpuscles,  and  epithelial  cells  let  fall  eyery 
day  by  the  urine,  and  although  suffering  from  other  effects 
of  disease  which  complicated  his  case,  the  kidneys,  on  the 
20th  of  October,  when  I  last  heard  from  him,  appeared  to 
have  become  gradually  restored,  if  not  to  health,  at  least 
to  a  condition  in  which  they  were  capable  of  performing 
their  normal  functions." 

The  waxy  or  Amyloid,  called  by  Dr.  Dickinson  the  De- 
purative  form  of  Bright's  disease,  much  less  common  in 
this  country  than  the  inflammatory  type,  is  characterized  by 
the  following  peculiarities  :  The  patient,  who  has  generally 
been  the  subject  of  some  long-continued  wasting  disease, 
such  as  tuberculosis,  scrofula,  caries,  syphilis,  etc.,  or  who 
is  naturally  of  a  feeble  constitution,  feels  more  thirst,  in- 
creased weakness,  and  finds  he  is  passing  more  water 
than  he  was  formerly  accustomed  to  do  ;  slight  oedema  of 
the  feet  and  ankles  is  observed,  and  the  urine,  on  examina- 
tion, is  found  to  be  albuminous,  and  to  contain  a  few  hya- 
line casts.  The  blood  shows  an  increased  proportion  of 
white  blood  corpuscles  and  a  marked  tendency  of  the  red 


80  MEDICAL  MICROSCOPY. 

globules  to  "tail,"  indicating  implication  of  the  lymphatic 
glands;  the  liver  and  spleen  enlarge  from  amyloid  de- 
posit into  their  substance ;  general  dropsy  gradually  comes 
on ;  the  urine  becomes  very  scanty,  highly  albuminous, 
but  not  of  great  specific  gravity,  and  contains  fatty  and 
hyaline  casts.  When  coma  or  convulsions  supervene,  as 
a  rule,  inflammatory  affection  has  been  added,  but  a  fatal 
result  is  more  apt  to  occur  from  an  exhausting  diarrhcBa 
or  from  phthisis.  Dr.  Stewart  further  remarks,  we  diag- 
nose the  Amyloid  by  the  increased  flow  of  urine,  albumi- 
nuria,  absence  of  dropsy,  previous  history,  complications 
and  appearance  of  the  patient,  i.e.  in  some  cases  (syphi- 
litic ?)  pasty,  waxy  complexion,  deposit  of  a  little  dark 
pigmentary  matter  in  the  skin,  especially  about  the  eyelids, 
and  an  air  of  general  debility ;  in  others  a  pale  and  clear 
face,  with  peculiar  congestion  on  the  cheeks  of  distended 
small  vessels,  quite  above  the  size  of  capillaries. 

As  an  example  of  this  form  of  the  affection,  I  quote  the 
following  case  from  p.  75  of  Dr.  Stewart's  work : 

"A.  C.,  sat.  30,  was  admitted  to  the  Royal  Infirmary 
(Edinburgh),  under  the  care  of  Dr.  Sanders,  May  30, 1864. 
She  stated  that  she  had  enjoyed  good  health  until  within 
four  weeks  of  her  admission,  but  for  some  months  before 
she  had  observed  that  she  passed  a  larger  quantity  of 
urine  than  natural.  She  was  obliged  to  get  up  several 
times  during  the  night  to  micturate.  She  had  a  little 
dropsy,  but  it  disappeared  on  the  occurrence  of  diarrhoea, 
a  few  weeks  before  admission.  Her  urine  was  pale,  of 
sp.  gr.  1010,  contained  much  albumen,  always  exceeded 
60  'oz.  daily,  although  she  was  affected  at  the  same  time 
with  severe  diarrhoea.  She  had  frequent  vomiting,  grad- 
ually became  exhausted,  and  died  June  28.  Her  family 
was  strumous.  There  was  no  positive  evidence  of  syphilis, 
but  she  had  a  cachectic  appearance,  and  complained  much 
of  pain  in  her  bones. 


URINE—  BRlGIirS   DISEASE.  81 

" Autopsy. — The  body  was  somewhat  emaciated  ;  the 
heart  and  lungs  were  natural.  The  bronchi  contained 
much  nmco-purulcnt  fluid.  The  liver  was  large,  weighed 
four  pounds  and  six  ounces,  was  bound  to  the  diaphragm 
by  numerous  old  adhesions;  it  was  fatty  and  waxy 
throughout;  both  the  cells  and  the  vessels  were  waxy. 
Both  kidneys  were  enlarged ;  the  left  weighed  9J  ounces, 
the  right  7^  ounces.  The  vessels  were  extremely  waxy, 
both  in  the  cortical  substance  and  in  the  cones.  The 
tubules  were  in  many  parts  distended  with  a  clear  hyaline 
material,  and  the  epithelium  was  in  many  parts  finely 
granular.  The  basement  membrane  of  the  tubes  also 
appeared  in  some  parts  waxy.  The  intestines  were 
waxy." 

In  the  cirrhotic  or  contracting  form  the  earlier  symp- 
toms are  very  slight,  and  may  often  escape  notice.  It  is 
especially  a  disease  of  male  adults,  more  frequent  in  ad- 
vanced life,  and  more  common  in  connection  with  the 
arthritic  diathesis.  In  some  cases  there  is  great  thirst 
and  frequent  micturition,  the  urine  being  pale,  of  low 
density,  often  below  1010,  and  in  amount  slightly  above 
the  natural  standard.  Albumen,  when  present,  is  generally 
in  very  small  quantity,  one  day  distinct  and  the  next  in- 
appreciable. Hyaline,  finely  granular  or  coarsely  granular 
tube-casts  mostly  occur,  but  are  apt  to  escape  observation. 
Not  unfrequently,  even  in  an  early  stage,  the  patient  suf- 
fers from  dyspnoea,  has  a  peculiar  anaemic  appearance, 
and  occasionally  finds  a  little  swelling  of  the  feet  and 
ankles ;  often  the  eyelids  are  puffy  and  the  conjunctiva 
dropsical,  presenting  the  character  styled  by  some  phy- 
sicians "the  Bright  eye."  As  the  disease  advances,  the 
patient's  strength  gives  way;  he  takes  cold  easily,  has  little 
power  of  reaction,  and  often  suffers  from  coronal  headache, 
the  albumen  increases  in  the  urine,  the  pulmonary  and 
gastric  symptoms  become  more  distressing,  and  finally 

8 


82  MEDICAL   MICROSCOPY. 

death  takes  place  from  uraemia,  apoplexy,  acute  oedema  of 
the  lungs,  or  some  intercurrent  inflammatory  affection. 

Sometimes  the  progress  of  the  disease  is  very  insidious 
and  gives  rise  to  no  characteristic  symptoms,  as  in  the 
following  example  : 

Ann  H.,  aged  28,  a  domestic  by  occupation,  born  in 
Ireland,  and  unmarried,  was  admitted  into  the  Pennsyl- 
vania Hospital,  on  the  28th  of  February,  1870,  for  a  slight 
attack  of  psoriasis  ;  she  was  rather  debilitated,  and  had 
been  the  subject  of  amenorrhoea  for  several  months,  but 
made  no  complaint  of  the  least  difficulty  connected  with 
the  urinary  apparatus.  On  the  5th  of  May  she  was 
weaker,  suffered  a  little  from  dyspnoea,  and,  in  spite  of 
treatment,  sank  exhausted  on  the  6th.  At  the  autopsy 
,the  chief  lesion  discovered  was  in  the  kidneys,  which  were 
much  contracted,  and,  on  microscopic  examination,  showed 
the  usual  evidences  of  advanced  Cirrhosis. 

Resuming  now  the  consideration  of  deposits  in  the 
urine  of  Bright's  disease,  it  will  perhaps  simplify  the  sub- 
ject a  little  if  we  divide  (for  the  purposes  of  microscopic 
investigation  only)  attacks  of  the  affection  where  casts 
occur  as  follows : 

CLASS  a. — Cases  in  which  the  urine  lets  fall  pale  granular 
and  hyaline  casts  of  small  diameter.  Fig. 
5,  c  and  d. 

CLASS  b. — Cases  where  the  urine  deposits  dark  granular 
casts  of  small  and  medium  diameter.  Fig. 
5,e. 

CLASS  c. — Cases  where  the  urinary  sediment  contains 
casts  with  numerous  epithelial  cells,  more  or 
less  fatty,  imbedded  in  them.  Fig.  5,  g. 

CLASS  d. — Cases  affording  many  examples  of  large  casts 
over  g^-  of  an  inch  in  diameter,  whether 
epithelial,  granular,  or  hyaline.  Fig.  5,  b. 


URINE—  BRIGIIT'S   DISEASE.  83 

According  to  this  method  of  arrangement,  under  Class 
a  are  grouped  cases  of  the  Amyloid  or  waxy  form,  of  the 
Cirrhotic  or  contracting  form,  and  of  that  chronic  Inflam- 
matory form  which  often  persists  for  months  after  an 
acute  attack  of  Bright's  disease.  The  differential  diag- 
nosis between  these  can  only  be  made,  as  above  remarked, 
by  a  thorough  investigation  into  the  general  symptoms 
and  previous  history,  although  some  assistance  may  fre- 
quently be  derived  from  the  number  and  character  of  the 
blood  corpuscles  associated  with  casts  in  the  urine,  as 
described  in  my  paper  in  the  American  Journal  of  Medi- 
cal Sciences  for  January,  1870,  p.  54.  From  observations 
and  experiments  there  detailed  I  conclude  that 

"  Whilst  red  and  white  corpuscles,  occurring,  as  de-  • 
scribed,  in  the  urine  in  their  normal  proportion,  point  to 
renal  hemorrhage,  and  the  same  elements,  when  more 
nearly  equal  in  number,  indicate  an  acute  or  subacute 
nephritis,  the  existence  of  white  blood  cells  (pus,  mucous, 
or  exudation  corpuscles)  alone  generally  shows  a  chronic 
or,  at  least,  less  active  inflammatory  condition  of  the  kid- 
neys: further,  that  a  series  of  comparative  examinations 
performed  with  the  precautions  above  detailed  at  inter- 
vals of  a  few  days  affords  an  important  guide  to  the  effect 
of  treatment,  and  to  the  progress  of  the  disease ;  and 
therefore  it  may  be,  I  think,  safely  asserted  that,  due 
regard  being  paid  to  the  general  symptoms  and  the  occur- 
rence of  albumen  and  tube-casts  in  Bright's  disease,  we 
can,  by  a  careful  study  of  the  corpuscular  blood  elements, 
as  seen  in  the  urine,  diagnosticate  the  form  and  stage  of 
the  renal  affection  with  much  more  accuracy  than  it  has 
heretofore  been  customary  to  do."  See,  also,  full  explana- 
tions in  Chapter  VI. 

To  distinguish,  then,  which  of  the  forms  above  enume- 
rated exists  in  a  patient  whose  urine  shows  the  characters 
of  Class  a,  we  must  carefully  investigate  the  history  of 


84  MEDICAL  MICROSCOPY. 

his  case  and  his  general  condition,  examining  each  of  the 
organs  in  turn  with  scrupulous  minuteness.  If  we  find 
that  in  former  years  he  has  been  the  subject  of  any  wast" 
ing  disease,  that  along  with  increasing  weakness  there 
has  been  an  increased  flow  of  albuminous  urine  without 
any  marked  dropsy,  and  especially  if  the  liver  and  spleen 
are  shown  by  percussion  and  palpation  to  be  decidedly 
enlarged,  and  diarrhoea  is  present,  the  probabilities  are 
great  that  we  have  to  do  with  the  Amyloid  form  of 
Bright's  disease.  Niemeyer  observes  (Text -Book  of 
Pract.  Medicine,  vol.  ii.  p.  42,  Humphreys  &  Hackley's 
Translation,  New  York,  1869):  "In  distinguishing  be- 
tween amyloid  degeneration  and  simple  parenchymatous 
nephritis,  Traube  lays  great  stress  upon  the  high  specific 
gravity  and  dark  color  of  the  urine  in  the  former  disease. 
My  own  observations  fully  confirm  the  truth  of  Traube's 
views,  and  I  may  add  that  I  have  been  struck,  not  only 
by  the  darkness  of  the  urine  in  amyloid  degeneration,  but 
also  by  its  unnatural  brownish-yellow  color;  moreover, 
my  colleague,  Hoppe  Seiler,  has  shown  that  such  urine 
contains  extraordinary  quantities  of  indican."  Should  in- 
quiry disclose  that  the  sick  man  is  of  a  gouty  or  rheumatic 
diathesis,  or  even  hereditary  tendency,  that  he  has  been 
a  sufferer  from  dyspepsia,  dyspnoea,  obstinate  cough  and 
headache,  that  h'is  eyelids,  feet,  and  ankles  are  somewhat 
or  moderately  cedematous,  and  that  he  has  been  for  a  long 
time  passing  an  excessive  amount  of  urine,  slightly,  if  at 
all,  albuminous,  the  presumption  is  that  he  is  the  victim 
of  Cirrhosis  of  the  kidney.  In  case  we  discover  that  the 
malady  under  which  our  patient  is  laboring  had  its  origin 
in  an  acute  febrile  attack  accompanied  with  scanty  high- 
colored  urine,  such  as  that  referred  to  in  the  case  quoted 
on  page  16,  the  deposit  must  further  be  carefully  examined 
for  red  and  white  blood  corpuscles,  whose  presence  would 
point  to  the  inflammatory  form  of  Bright's  disease.  In 


URINE—  BRIGIIT'S    DISEASE.  85 

order,  however,  to  guard  the  microscopist  against  a  fal- 
lacy which  may  here  creep  in  through  mistaking  blood 
corpuscles  from  the  bladder  as  the  result  of  nephritis,  I 
quote  the  following  from  my  paper  above  alluded  to : 

"Among  the  means  of  distinguishing  when  the  effused 
blood  is  of  vesical  and  when  of  renal  origin,  it  is  to  be  noticed 
that  the  seat  of  pain  or  soreness  on  pressure  is  one  of  the 
most  important;  of  less  general  application,  although  of 
course  more  positive  when  it  occurs,  is  the  existence  of 
tube-casts  in  the  urine,  which,  when  indubitable,  prove,  I 
believe,  that  we  have  to  deal  with  nephritis ;  care  must, 
however,  be  taken  to  avoid  confounding  accidental  aggre- 
gations of  matter  with  genuine  casts  from  the  uriniferous 
tubules.  It  is  not,  I  believe,  common  to  meet  with  more 
than  two  or  three  specimens  of  the  rounded  epithelium 
from  the  uriniferous  tubules  upon  a  single  slide,  unless 
desquamative  nephritis  exists ;  and  should  the  cells  exhibit 
distinct  oil  globules,  even  although  not  more  than  -g^-^ 
of  an  inch  in  diameter,  great  force  would  be  added  to  the 
presumption  of  Bright's  disease,  derived  from  the  presence 
of  the  blood  elements  associated  with  renal  epithelium.  It 
is  also,  I  think,  rare  for  us  to  detect  the  amoeboid  move- 
ment, and  unusual  to  find  even  the  irregular  shape  which 
precedes  the  complete  death  of  the  motionless  leucocyte  in 
pus  (white  blood)  corpuscles  from  the  kidney;  while  this 
motion  may  often  be  observed  in  the  urine  of  cystitis, 
especially  if  examined  while  fresh  and  without  being 
allowed  to  cool  below  the  normal  temperature  of  the  body. 
As  mentioned  by  Prof.  Beale,  phosphatic  crystals  seldom 
occur  with  pus-cells  from  the  kidney,  a  useful  aid  to  diag- 
nosis when  we  are  able  to  exclude  suspicion  of  coexisting 
trouble  about  the  bladder.  Of  course  the  detection  of 
tube-casts  with  red  and  white  corpuscles  imbedded  in  their 
substance  is  a  positive  index  of  Bright's  disease." 

When  the  urine  of  a  patient  is  discovered  on  microscopic 


86  M~EDWAL  MICROSCOPY. 

examination  to  belong  to  Class  &,  and  numerous  red  blood 
corpuscles,  either  decolorized  or  crenated,  also  occur  in  it, 
we  shall  probably  find  the  patient  feverish,  dropsical,  and 
urinating  scantily, — in  a  word,  presenting  the  symptoms  of 
the  acute  stage  of  the  Inflammatory  form  in  greater  or  less 
intensity.  When  dark  granular  casts  occur  without  red 

FIG.  6. 


CASTS  OP  URINIFEROUS  TUBULES,  SHOWING  BLOOD  CORPUSCLES  AND  EPITHELIAL  CELLS 

CONTAINING  SMALL  OlL  tlLOBULES. 

a.  Red  blood  disks,  one  of  them,  at  e,  "Crenated."    6.  White  blood  globule,     c. 
Fatty  epithelial  cells,    d.  Granular  epithelial  cells.    X  1200  diameters  (gM^)- 

blood  corpuscles,  and  in  chronic  stages  of  the  disease,  they 
generally  have  a  blackish  instead  of  a  brownish  tinge,  and 


URINE— BRIGHT*  B  DISK  AS/:.  s7 

consist  of  broken-down  epithelial  cells  and  minute  oil  glob- 
ules, which  (if  very  few  or  no  casts  belonging  to  Class  c 
are  present  in  the  urine)  have  been  probably  formed  in  the 
tubules  during  a  previous  acute  attack,  and  are  gradually 
being  washed  out  by  the  urinary  flow.  It  must  not  be  for- 
gotten that  pale  hyaline  and  even  mucous  casts  sometimes 
become  coated  with  a  deposit  of  amorphous  urates,  so  as  to 
appear  darkly  granular ;  this  condition  may  be  detected  by 
gently  warming  the  urine  and  so  dissolving  the  saline 
material. 

The  indications  of  Class  c  point  toward  the  existence  of 
the  second  stage  of  the  inflammatory  form  of  Bright's 
disease,  that  of  Fatty  degeneration,  either  alone  or  asso- 
ciated with  more  or  less  amyloid  degeneration.  If  inves- 
tigation reveals  a  history  of  the  origin  of  tbe  complaint  in 
an  acute  attack,  or  of  well-marked  acute  symptoms  super- 
vening in  the  course  of  the  affection  (as  in  the  case  of 
Ellen  G.,  narrated  p.  76),  tf  the  liver  and  spleen  show  no 
signs  of  enlargement,  and  if  the  dropsy  is  extensive,  while 
the  strength  is  comparatively  unimpaired,  the  patient  is 
probably  free  from  amyloid  disease ;  while,  should  the 
reverse  exist,  its  presence  is  extremely  probable.  In  regard 
to  the  extent  of  fatty  transformation,  much  may  be  learned 
by  observing  the  number  and  size  of  the  oil  globules  in 
the  epithelial  cells,  which,  if  generally  fatty  and  occupied 
by  large  particles  of  oil  ^Vrr  of  an  inch  or  more  in  diam- 
eter, indicate  that  the  transformation  is  far  advanced,  and 
that  permanent  improvement  can  scarcely  be  looked  for. 

The  casts  in  urine  belonging  to  Class  d  should  theoreti- 
cally be  formed  in  tubes  that  have  been  quite  denuded  of 
their  epithelial  lining,  or  even  have  undergone  distention 
of  their  caliber,  and,  in  my  experience,  have  almost  always 
occurred  in  very  advanced  stages  of  the  complaint.  Never- 
theless, as  Dr.  Beale  (whose  observations  have  been  far 
more  extended  than  my  own)  states  that  they  are  often 


88  MEDICAL  MICROSCOPY. 

formed  in  the  wide  portions  of  the  tubules,  and  may  be 
seen  in  some  forms  of  renal  disease  which  are  temporary 
and  comparatively  unimportant,  the  gravity  of  this  symp- 
tom must  not  be  overestimated.  The  form  of  the  affection 
in  which  these  large  casts  occur,  must  be  decided  by  the 
accompanying  deposits,  history  of  the  case,  etc.,  as  pre- 
viously suggested ;  and  if  the  complaint  is  in  reality  ap- 
proaching a  fatal  issue,  the  symptoms  will  generally  be 
so  pronounced  that  we  may  readily  arrive  at  a  correct 
diagnosis. 

Of  course,  instances  will  occur  to  every  one  where  the 
casts  deposited  from  the  urine  will  partake  of  one  or 
more  of  the  characters  I  have  endeavored  to  classify,  and 
in  such  case  the  microscopist  must  be  guided  by  the  pre- 
ponderating element,  should  a  majority  of  the  casts  be  of 
one  kind,  or  if  specimens  of  different  varieties  nearly  equal 
each  other  in  number,  he  may  be  compelled  to  withhold 
an  opinion  until  future  examinations  throw  further  light 
upon  the  nature  of  the  attack.  On  the  other  hand,  if,  m 
successive  examinations  made  at  intervals  of  a  few  days 
or  weeks,  the  tube-casts  are  found,  from  being  darkly 
granular  and  associated  with  blood  corpuscles  in  the 
ratio  of  one  white  to  fifteen  or  twenty  red,  to  change  to 
pale,  granular,  and  hyaline,  associated  with  red  and  white 
blood  corpuscles  in  nearly  equal  proportions,  or  with 
leucocytes  alone,  a  diagnosis  of  the  inflammatory  form 
of  Bright's  disease,  commencing  as  an  acute  attack  and 
passing  into  the  chronic  stage,  might  almost  be  predicated 
simply  upon  these  facts :  in  a  similar  manner,  should  casts 
which  indicate  acute  nephritis  be  gradually  replaced  in 
the  urine  by  those  belonging  to  Class  c  as  above  denned, 
the  presumption  would  be  very  strong  that  the  inflamma- 
tory^form  was  passing  rapidly  into  the  stage  of  fatty  de- 
generation, andaprognosis  correspondingly  grave,  although 
by  no  means  necessarily  fatal,  should  be  given.  Let  me 


URINE— BRIGHT^  DISEASE.  s«i 

indeed  warn  the  young-  microscopist  against  assuming  that 
because  serious  disease  of  the  kidneys  is  found  to  exist  in 
any  given  patient  he  is  therefore  condemned  to  death  from 
Bright's  disease;  for  just  as  a  man  may  live  long  with  im- 
portant disorganization  of  the  heart  or  any  other  vital  organ, 
until  he  is  attacked  with  some  accidental  disease  of  a  con- 
stitutional character  that  breaks  down  the  already  crippled 
powers  of  life  and  so  proves  mortal,  so  an  individual  with 
extensive  but  chronic  nephritis  may  live,  even  enjoy  life, 
for  years,  and  at  last  fall  a  victim  to  some  other  affection. 

And  here  let  me  state  my  firm  belief  that  in  the  con- 
stant examination  of  all  the  organs,  whenever  we  are 
called  to  treat  any  derangement  of  health,  however  trivial, 
we  will  yet  find  the  clue  to  comprehending  those  remark- 
able variations  of  disease  which  have  always  puzzled  even 
the  masters  in  our  profession,  and  by  so  doing  be  able  to 
confound  cavilers  at  the  value  of  statistics  (who  scoffingly 
declare  that  though  we  know,  for  example,  that  one  patient 
in  seven  will  die  of  typhoid  fever,  our  art  fails  to  indicate 
which  one  of  the  seven  is  doomed  to  death),  by  pointing 
out,  with  the  aid  of  the  stethoscope  and  the  microscope, 
that  because  such  a  one  (though  apparently  in  average 
health  before  the  attack)  had  valvular  affection  of  the  heart 
and  fatty  degeneration  of  the  kidneys,  his  strength  must, 
in  all  human  probability,  give  way  under  the  accumulated 
load  of  disease. 

Dr.  George  Harley  (Diabetes,  its  Various  Forms  and 
Different  Treatments,  London,  1866,  p.  65)  observes: 
"  When  sugar  permanently  appears  in  the  urine  in  the 
course  of  albuminuria,  fears  for  the  safety  of  the  patient 
are  to  be  entertained,  because  it  generally  indicates  a  loss 
of  vital  energy." 

Prof.  Austin  Flint,  in  a  very  valuable  contribution 
to  the  New  York  Medical  Record,  July  15,  1869,  On 
Prognosis  in  Bright's  Diseases  (Half -Yearly  Abstract, 


90  MEDICAL  MICROSCOPY. 

Jan.  18TO),  affirms  that  desquamative  nephritis  may,  and 
perhaps  commonly  does,  end  in  recovery,  leaving  the 
structure  of  the  kidneys  intact.  Whether  recovery  from 
the  condition  of  smooth  white  kidney  and  fatty  kidney 
ever  occurs  it  is  impossible  to  say ;  but  it  is  "  highly  prob- 
able that,  having  progressed  to  a  certain  extent,  the  mor- 
bid process  or  processes,  whether  inflammatory  or  not, 
which  these  diseases  involve,  may  cease,  and  retrogression 
take  place,  leaving,  at  length,  the  organs,  if  not  intact,  not 
damaged  enough  to  compromise  seriously  their  functional 
capacity."  (See,  also,  An  Analysis  of  One  Hundred  and 
Two  Cases  of  Bright's  Diseases,  by  the  same  author, 
Bellevue  and  Charity  Hospital  Reports,  1870.) 

As  remarked  by  Dr.  Aitkin  (p.  125,  vol.  ii.,  Science  and 
Practice  of  Medicine,  London,  1866),  "  Without  a  micro- 
scopic examination  of  the  urine  from  day  to  day,  it  is  im- 
possible to  distinguish  between  a  case  likely  to  improve 
under  treatment  and  one  which  may  be  viewed  as  hope- 
less;  and  without  the  daily  use  of  the  microscope  the 
treatment  becomes  at  the  best  but  merely  guess-work." 

In  the  management  of  acute  Bright's  disease,  attended 
with  high  fever,  intense  dropsy,  and  severe  pain  in  the 
lumbar  regions,  the  indications  are — first,  to  relieve  the 
congested  or  inflamed  condition  of  the  kidneys  by  local 
depletion,  such  as  cupping  or  leeching  upon  the  loins,  or, 
in  rare  cases,  by  venesection,  following  this  up  by  revul- 
sion from  the  bowels,  which  should  be  acted  upon  by 
hydragogue  cathartics,  energetic  in  proportion  to  the 
strength  of  the  patient,  such  as  jalap,  scammony,  gam- 
boge, or  elaterium,  mercurials  being  avoided;  and  second, 
to  cause  the  bowels,  the  skin,  and  the  lungs  to  perform,  as 
much  as  possible,  vicarious  nephritic  duty,  so  as  to  permit 
congestion  and  irritation  of  the  kidneys  to  subside  under 
the  influence  of  the  treatment.  For  this  latter  purpose, 
the  purgative  effect  first  induced  may  be  kept  up  by  mod- 


URINE—  BRIG II T' S  DISEASK.  <>1 

erate  doses  of  citrate  of  potash  or  citrate  of  magnesia; 
free  perspiration  should  be  promoted  by  the  hot  water* 
or  hot  air  bath  and  the  use  of  acetate  of  ammonia  with 
small  doses  of  tincture  of  aconite  or  of  antimonial  wine, 
which  will  also  assist  elimination  of  fluid  by  the  bronchial 
mucous  membrane.  Much  difference  of  opinion  exists  as 
to  the  propriety  of  using  diuretics  in  this  stage.  Thus, 
for  example,  Dr.  George  Harley  observes  (Albuminuria 
with  and  without  Dropsy,  p.  54) :  "  In  the  first  place,  it 
ought  never  to  be  forgotten  that  in  acute  Bright's  disease, 
as  well  as  in  the  first  stage  of  all  inflammatory  and  con- 
gestive attacks  occurring  in  the  course  of  chronic  kidney 
affections,  diuretics  are  inadmissible.  In  the  second  place, 
it  must  be  borne  in  mind  that  great  care  should  always  be 
observed  in  their  selection ;  for  a  diuretic  which  will  prove 
beneficial  in  one  form  and  at  one  particular  stage  of  renal 
disease  will  often  not  only  do  no  good,  but  actual  harm, 
when  administered  in  another  form  or  at  another  stage  of 
the  same  attack.  Thus,  whenever  the  albuminuria  is  the 
result  of  active  congestion,  the  antiphlogistic  variety  of 
diuretic — such,  for  example,  as  a  combination  of  bitartrate 
of  potash  and  digitalis — is  to  be  selected ;  whereas,  in  the 
absence  of  active  congestion,  and  more  especially  when 
the  vital  powers  of  the  patient  are  low,  the  stimulating 
variety  of  diuretic  may  not  only  be  used  with  impunity, 
but  with  actual  advantage.  The  reason  why  the  employ- 
ment of  diuretics  often  does  harm  in  acute  kidney  affec- 
tions is  readily  understood  when  we  recollect  that  they 
have  always  the  tendency  rather  to  increase  than  diminish 
the  flow  of  blood  to  the  already  engorged  organ." 

*  As  a  convenient  substitute,  Dr.  Roberts  recommends  that  a 
large,  thick  blanket  should  be  wrung  as  dry  as  possible  out  of 
boiling  water  and  wrapped  around  the  body  of  the  patient ;  the 
bedclothes  are  then  heaped  on.  In  twenty  minutes  or  half  an 
hour  the  hot  blanket  is  removed  and  the  surface  quickly  dried 
with  a  warm,  soft  towel. 


92  MEDICAL  MICROSCOPY. 

Drs.  Roberts  and  Grainger  Stewart,  however,  assert 
that  this  prejudice  against  the  use  of  diuretics  has  been 
proved  quite  unfounded  by  ample  experience,  which  has 
established  the  value  of  the  treatment  by  their  aid.  Among 
these  remedies,  Dr.  Stewart  especially  recommends  digi- 
talis in  the  form  of  infusion,  acetate  and  nitrate  of  potash, 
oil  of  juniper  in  tincture  (or  by  inhalation  from  a  sponge 
dipped  in  hot  water),  infusion  of  broom,  and,  last  but  not 
least,  pure  water.  It  seems  to  me,  however,  that  diuretics, 
which  increase  the  flow  of  urine  by  their  influence  upon 
the  process  of  exosmosis  instead  of  by  their  stimulating 
action,  will  probably  prove  most  beneficial  when  renal 
congestion  already  exists.  Mercurials  should  be  avoided, 
because  severe  salivation  sometimes  follows  very  small 
doses.  Dr.  Roberts  states  that  two  grains  of  blue  pill  ad- 
ministered with  extract  of  colocynth,  on  two  alternate 
mornings,  produced  profuse  ptyalism  in  one  of  his  patients. 

The  management  of  consequent  and  casual  complica- 
tions is  sometimes  very  important,  and  should  receive 
particular  attention.  Obstinate  vomiting  may  be  treated 
with  bismuth  and  morphia,  creasote,  small  pieces  of  ice, 
hydrocyanic  acid,  or  minute  doses  of  chloroform ;  and  dys- 
pnoea, when  cardiac,  as  it  frequently  is,  may  often  be 
relieved  by  the  aromatic  tincture  .of  valerian,  or  very 
scanty  inhalations  of  ether  or  chloroform.  When  uraemia 
comes  on,  renewed  efforts  must  be  made  to  promote  the 
flow  of  urine;  and  should  convulsions  occur,  chloroform 
inhalations,  and,  in  rare  cases  of  vigorous  subjects,  vene- 
section, may  be  resorted  to.  Frerichs,  on  the  theory  that 
so-called  ursemic  poisoning  is  produced  by  carbonate  of 
ammonia,  recommends  the  free  use  of  acids,  but  since  the 
experiments  of  Oppler,  Zalesley,  etc.  have  shown  the 
fallacy  of  such  views,  little  benefit  can  be  expected  from 
their  administration.  The  secondary  thoracic  complica- 
tions, pneumonia,  pericarditis,  etc.,  are  often  of  unusual 


URINE—  BRIGllT'S  DISEASE.  93 

severity,  and  yet  occur  when  the  patient  is  too  feeble  to 
bear  the  ordinary  antiphlogistic  treatment.  Our  chief  re- 
source under  such  circumstances  must  be  in  dry  cupping 
and  counter-irritants  ("distant  stimulants"),  such  as  chloro- 
form and  mustard,  avoiding  cautharides  and  turpentine. 

The  diet  in  the  early  stages  should  be  simply  farina- 
ceous, with  beef-tea  or  chicken  soup,  if  necessary,  to  sup- 
port the,  strength  ;  later,  it  may  be  advisable  to  resort  to 
more,  or  even  the  most  nutritious  aliments.  As  stimu 
lants,  brandy  in  the  early  and  gin  in  the  more  chronic 
stages  are  to  be  preferred,  and  should  be  given  diluted 
and  sweetened  to  the  taste.  A  complete  suit  of  flannel 
should  be  worn  next  to  the  skin,  even  while  confined  to 
the  bed  or  the  house,  and  residence  in  a  southern  climate, 
such  as  that  of  Florida  or  Havana,  will  often  prove  of 
much  benefit. 

The  prognosis  of  chronic  Bright's  disease,  although 
generally  unfavorable,  is  by  no  means  so  necessarily  or 
immediately  fatal  as  is  popularly  supposed,  instances  of 
recovery  being  not  at  all  rare.  According  to  Dr.  Roberts, 
the  unfavorable  symptoms  are  "  obstinate  dryness  of  the 
skin,  the  urine,  which  had  previously  been  abundant,  be- 
coming steadily  scantier,  without  proportionate  increase 
in  the  specific  gravity,  evidence  that  the  disease  has  ex- 
isted for  some  years,  repeated  recurrence  of  uraemic  phe- 
nomena, excessive  serous  effusion,  excessive  cardiac  hyper- 
trophy, a  persistently  feverish  state.  Speedy  death  is 
indicated  by  the  breaking  forth  of  pneumonia  or  pericar- 
ditis, by  suppression  of  urine,  or  uncontrollable  vomiting 
and  diarrhoea."  Dr.  Beale  remarks  that  "  if  the  patient  is 
very  stout,  appearing  to  be  in  rude  health,  florid  and  full- 
blooded,  when  the  attack  first  appears,  and  especially 
when  dropsy  comes  on  early,  and  is  considerable,  with 
nausea,  some  dyspncea,  quick  pulse,  and  irritable,  weak 
heart,  but  without  any  evidence  of  the  attack  being  acute, 

9 


94  MEDICAL  MICROSCOPY. 

the  prognosis  is  bad,  and  the  case  is  likely  to  terminate 
fatally  in  a  short  time." 

The  indications  for  treatment  in  the  chronic  form  are — 
first,  to  remove  the  patient  as  far  as  possible  from  the  in- 
fluence of  causes  or  habits  which  have  brought  on  the 
disease,  and  to  impress  upon  him  the  absolute  necessity  of 
living  within  the  bounds  of  his  reduced  vital  circumstances, 
that  is,  in  accordance  with  his  crippled  powers  of  life  ; 
second,  in  the  administration  of  iron  and  the  mineral  acids, 
the  tincture  of  the  sesquichloride  probably  surpassing  all 
others  in  efficacy,  when  it  can  be  borne  by  the  system, 
although  it  may  be  replaced  in  part  by  the  citrate  of  iron 
and  quinine  or  strychnia,  the  lactate  of  iron,  the  saccha- 
rated  carbonate,  or  the  iodide  of  iron ;  and,  thirdly,  in  the 
employment  of  remedial  measures  such  as  those  already 
described  for  the  control  or  cure  of  the  dropsy  and  other 
attendant  complications. 

Dr.  Dickinson  recommends  in  the  management  of  the 
waxy  or  Amyloid  form  the  free  use  of  potash  and  soda  to 
supply  the  deficiency  of  alkaline  constituents  in  the  blood, 
which  he  believes  to  exist ;  and  the  method  is  certainly 
worthy  of  more  extended  trial.  The  Cirrhotic  form  is  the 
least  amenable  to  treatment,  except  in  cases  where  it  pro- 
ceeds from  lead-poisoning,  when  benefit  may  often  be  ob- 
tained from  the  administration  of  iodide  of  potassium  or 
of  dilute  sulphuric  acid. 

On  theoretical  grounds,  Kiichenmeister  advises  lime- 
water  in  large  doses  in  Bright's  disease  and  Nephritis 
following  scarlatina,  because  of  its  property  of  dissolving 
proteine;  and,  as  an  empirical  remedy,  the  infusion  of  Sam- 
bucus  Canadensis  in  hard  cider  has  of  late  been  highly 
lauded  by  Dr.  McNutt,  of  Marshall,  Missouri.  (See  Am. 
Jour,  of  Med.  Sciences,  July,  1869.) 


CHAPTER   IV. 

EXAMINATION   OF   URINE. 

Division  1. — Light  or  Flocculent  Deposits. 

SECTION  B. — Mucus,  Spermatozoa  and  Fungous  Growths. 

ALTHOUGH  the  light  or  flocculent  deposit  let  fall  from 
the  urine  under  consideration  may  possibly  consist  of 
blood  or  of  pus,  yet,  since  these  ingredients  generally 
form  a  sediment  of  small  bulk  occupying  the  bottom  of 
the  vessel,  and  occur  in  albuminous  urine,  they  will  be 
described  under  the  head  of  Granular  or  Crystalline  De- 
posits, to  which  the  reader  is  referred.  The  only  form  of 
the  Leucocyte*  to  be  considered  here,  therefore,  as  a  con- 
stituent of  the  non-albuminous  renal  secretion,  is  the 
mucous  corpuscle,  which,  as  more  fully  detailed  in  Chap- 
ter VI.,  may  vary  from  the  -^oVfr  to  the  14100  of  an  inch  in 
diameter,  according  to  the  density  of  the  fluid  in  which  it 
floats. 

Viewing,  as  I  think  we  now  must  do,  the  pus,  mucous, 
and  white  blood  corpuscles  as  precisely  identical,  it  be- 
comes simply  impossible  to  distinguish  the  fluids  in  which 

*  While  differing  somewhat  from  M.  Ch.  Eobin  in  regard  to  the 
histological  structure  of  the  white  blood  corpuscle,  I  prefer  to  uso 
the  convenient  name  of  Leucocyte,  introduced  by  that  distin- 
guished microscopist,  as  a  term  for  all  the  various  bodies  denom- 
inated by  different  writers  pus  corpuscles,  exudation  globules, 
pyoid  corpuscles,  mucous  corpuscles,  salivary  globules,  etc.,  which 
recent  investigations  tend  to  show  are  one  and  the  same  anatomi- 
cal element.  See  Chapter  VIII.,  On  the  Examination  of  Pus,  etc. 

(95) 


96  MEDICAL  MICROSCOPY. 

they  respectively  occur  (pus,  mucus,  and  blood)  from  each 
other  by  differences  of  the  size,  shape,  number  of  nuclei, 
etc.  of  their  Leucocytes,  so  that  we  will  be  obliged  to  seek 
some  other  modes  of  recognizing  them  than  those  taught 
by  the  older  microscopists.  I  shall,  however,  reserve  the 
full  discussion  of  this  subject  for  a  future  chapter,  merely 
remarking  here  tfyat  in  blood  we  of  course  find,  with  the 
microscope,  not  only  the  red  and  white  corpuscles,  but,  on 
testing  with  heat  and  nitric  acid,  albumen  of  the  Liquor 
sanguinis ;  in  healthy  mucus,  which  is  a  secretion,  we 
have  only  the  Leucocytes  suspended  in  a  fluid  which, 
having  been  acted  upon  by  the  "  germinal"  matter  of  the 
epithelial  cells,  no  longer  contains  albumen  (or,  at  least, 
albumen  coagulable  by  ordinary  reagents)  ;  while  in  pus, 
which  is  an  exudation,  we  find  Leucocytes  floating  in  the 
blood  serum,  which,  having  transuded  through  the  walls 
of  the  vessels,  constitutes,  in  a  more  or  less  pure  condi- 
tion, the  Liquor  puris. 

The  appearance  of  mucus  can  be  very  satisfactorily 
studied  in  healthy  urine,  where  it  generally  forms  a  light, 
semi-translucent  cloud  occupying  the  lower  fourth  or  fifth 
of  the  fluid  ;  if  a  small  portion  of  this  be  placed  upon  a  slide, 
as  directed  in  the  last  chapter  (p.  69),  and  examined  with  a 
power  of  200  diameters,  a  few  rounded  or  oval  cells,  about 
WW  °f  an  incn  across>  WM  b<3  seen  imbedded  in  the  trans- 
parent mucin,  which  is  sometimes  almost  invisible,  and  at 
others  presents  a  delicately  fibrillated  appearance;  together 
with  these,  a  small  number  of  epithelial  cells  from  the 
various  parts  of  the  urinary  tract  may  generally  be  de- 
tected. Should  any  portion  of  this  extensive  mucous 
membrane  become  irritated  or  diseased,  we  shall  find  in 
the  urinary  deposits  not  only  a  much  greater  abundance 
of  Leucocytes,  but  also  numerous  cells  of  its  epithelium, 
which  in  this  way  become  guides  to  the  actual  seat  of 
derangement.  (See  Fig.  f.) 


URINE— MUCUS,  SPERMATOZOA,  ETC.  97 

Tin*  epithelium  of  the  bhidder  (Fig.  7, 2),as  stated  by  Dr. 
Beale,  "varies  much  in  different  parts  of  the  organ;  in  the 
fuudus  there  is  much  columnar  epithelium,  mixed  with  large 
oval  cells ;  whereas  in  that  part  termed  the  trigone  large 
and  slightly  flattened  cells,  with  a  very  distinct  nucleus 
and  nucleolus,  are  most  abundant.  Columnar  epithelium 
appears  to  line  the  mucous  follicles,  while  the  scaly  lies  on 
the  surface  of  the  mucous  membrane  between  them. 
Many  of  these  large  oval  cells  of  bladder  epithelium  lie 
upon  the  summits  of  several  columnar  cells,  and  their 
under  surface  exhibits  corresponding  depressions.  The 
epithelial  cells  of  the  urethra  (l)  are  for  the  most  part  of 
the  columnar  form,  but  mixed  with  this  there  is  also  a  good 
deal  of  scaly  epithelium.  Toward  the  orifice  the  epithe- 
lium is  almost  entirely  of  the  scaly  variety.  The  cells 
from  the  ureter  (3)  are  of  the  columnar  form,  and  some  are 
spindle-shaped.  In  form  and,  indeed,  in  their  general  ap- 
pearance these  cells  much  resemble  those  found  in  some 
schirrous  tumors.  Care  must  be  taken  not  to  mistake 
them  in  cases  of  suspected  cancer  of  the  kidney.  The 
epithelium  of  the  kidney  differs  somewhat  in  its  charac- 
ters in  different  parts  of  the  tube  and  also  at  different 
ages.  That  in  the  convoluted  or  secreting  portion  of  the 
tube  (5)  is  described  as  being  polygonal ;  it  projects  into 
the  tube  to  the  extent  of  one-third  of  its  caliber.  The  epi- 
thelium in  the  straight  portion  of  the  tube  is  flatter  and 
approaches  to  the  tessellated  variety."  The  epithelium 
from  the  pelvis  of  the  kidney  (*)  is  in  part  tessellated  and 
in  part  columnar,  like  that  of  the  ureter. 

As  the  method  of  investigating  a  fluid  for  epithelial 
cells  has  already  been  very  fully  described,  it  seems  un- 
necessary to  repeat  any  directions  for  their  detection  in 
urine,  the  process  for  a  tyro  being  precisely  analogous  to 
that  given  on  page  47. 

Many  specimens  of  urine  are  supposed  to  contain  large 

9* 


98 


MEDICAL   MICROSCOPY. 


amounts  of  mucus,  when  in  reality  the  ropy,  transparent 
deposit  is  composed  of  pus  altered  in  this  way  by  carbo- 
nate of  ammonia  derived  from  the  decomposition  of  urea 


FIG.  7. 


3.  4.  5. 

EPITHELIAL  CELLS  OF  THE  URINARY  TRACT.    X  215  Diameters.    (After  Beale.) 

1.  Epithelium  from  the  urethra.  2.  Ditto  from  the  bladder.  3.  Ditto  from  the 
ureter.  4.  Ditto  from  the  pelvis  of  the  kidney.  5.  Ditto  from  the  convoluted  por- 
tions of  the  uriniferous  tubules  ;  a.  Treated  with  acetic  acid. 

(or  by  reaction  with  basic  phosphate  of  soda,  as  suggested 
by  Dr.  Owen  Rees);  such  cases  may  generally  be  recog- 
nized by  examining  the  urine  immediately  after  it  is 
passed,  or,  if  necessary,  by  washing  out  the  bladder  and 
drawing  off  a  specimen  an  hour  or  two  afterward.  Mucus 
sometimes  appears  in  the  urine  in  the  form  of  casts  either 
of  the  uriniferous  or  of  the  seminiferous  tubules ;  the 


URFNE—  MUCITS,  SPERMATOZOA,   /  <.i<) 

former  of  these  two  may  generally  be  distinguished  from 
tube-casts  of  Bright's  disease  by  being  often  long,  bent, 
twisted,  and  sometimes  branched,  while  the  latter  are 
mostly  of  much  greater  size,  and  contain  spermatozoa. 
When  a  deposit  of  amorphous  urates  occurs  upon  casts  of 
this  character,  they  may  strongly  resemble  the  pale  gran- 
ular or  dark  granular  casts  of  nephritis,  but  may  be  dis- 
tinguished by  becoming  transparent  when  the  urine  is 
warmed,  by  that  fluid  not  being  albuminous,  and  by  the 
absence  of  symptoms  of  Bright's  disease.  Mucous  casts 
of  the  uriniferous  tubules  generally  accompany  an  irritable 
condition  of  the  bladder  of  long  standing,  and  probably 
often  indicate  a  sympathetically  unhealthy  condition  of 
the  renal  organs. 

Should  the  Light  or  flocculent  deposit  under  considera- 
tion fail  to  exhibit  the  appearances  above  described  as 
characteristic  of  mucus,  the  examination  should  be  care- 
fully repeated  upon  another  specimen,  as  before  directed,  for 
Spermatozoa.  Of  course,  in  actual  practice  these  bodies, 
as  well  as  tube-casts,  etc.,  will  all  be  looked  for  upon  a 
single  slide  and  in  every  field ;  but  for  beginners,  and  for 
the  purpose  of  description,  it  will  be  more  convenient  to 
consider  them  as  discovered  by  separate  research. 

In  examining  the  urine  for  Spermatozoa,  a  small  portion 
of  the  light  cloud  which  they  form  (sometimes  so  faint 
as  to  be  almost  imperceptible)  should  be  covered  with 
thin  glass  upon  a  slide  and  investigated  as  directed  on 
page  69,  with  an  amplification  of  200,  although  they  may 
be  more  readily  and  certainly  detected  by  using  a  higher 
power,  such  as  400  or  600  diameters. 

As  will  be  seen  by  the  accompanying  figure,  these  little 
bodies  present  the  appearance  of  minute  tadpoles  with 
greatly  elongated  tails.  The  length  of  the  head  is  about 
-5^5-  of  an  inch,  and  that  of  the  tail  averages  ^-^  of  an 
inch.  The  whole  spermatozoon  has  a  peculiar  bluish  tint, 


100 


MEDICAL  MICROSCOPY. 


PIG.  8. 


and  a  kind  of  fatty  luster,  which  renders  it,  like  the  spores 
of  the  yeast-plant  and  some  hyaline 
tube-casts,  most  easily  detected  when 
just  outside  of  or  beyond  the  exact 
focus.  As  seen  in  the  urine,  they  are 
almost  always  motionless,  their  re- 
markable movements  promptly  ceas- 
ing on  contact  with  any  acid  liquid, 
but  when  detected  in  healthy  alka- 
line vaginal  mucus  (see  Chap.  XII.) 
their  very  active  vibrations  are  often 
plainly  visible.  The  appearances  of 
spermatozoa  are  so  characteristic 
that,  as  a  rule,  there  is  little  danger 


SPERMATOZOA.    (After  Kol- 
liker.) 

1.  Magnified    250    diam- 
eters. 

2.  Magnified    600   diam- 
eters. 

a.  Viewed  from  the  side. 
6.        "  "         back. 


of  their  being  mistaken.     In  an  in- 


teresting case  which  occurred  in  the 
Pennsylvania  Hospital  during  the 
summer  of  1869,  a  specimen  of  urine 
which  exhibited  numerous  small 
crystals  of  oxalate  of  lime  and  a  great 
many  tiny  fragments  of  cotton  fiber 
was  pronounced  by  the  resident  physician  to  contain  also 
a  few  spermatozoa ;  and  under  the  hospital  microscope,  with 
a  power  of  250,  certain  bodies  were  to  be'  seen  which 
did  indeed  strongly  resemble  the  products  of  the  testicle, 
except  that  I  thought  their  tails  had  not  their  character- 
istic regular  decrement  in  diameter  from  their  cephalic 
to  their  opposite  extremity.  On  examining  a  specimen  at 
home,  however,  under  my  own  instrument,  with  a  power 
of  about  1200,  I  found  that  the  head  of  each  of  these 
bodies  was  composed  of  a  minute  crystal  of  oxalate  of  lime, 
which,  having  deposited  itself  upon  the  end  of  a  little 
fiber  of  cotton  about  the  length  of  a  spermatozoon's  tail, 
contrived  in  that  way  to  present  a  most  respectable  coun- 
terfeit of  the  genuine  Homunculi,  as  old  anatomists  used 


URTNE—  MUCUS,  SPERMATOZOA,  ETC.  \(\\ 

to  call  spermatozoa.  Dr.  Beale  gives  in  his  work  on 
Kidney  Diseases  (opposite  p.  330)  a  drawing  of  some 
vegetable  filaments  resembling  spermatozoa.  I  have  never 
met  with  such  a  growth,  but  should  suppose  from  his 
plate,  which  is  of  course  an  accurate  delineation,  that  it 
might  be  detected  by  the  fact  that  a  few  of  the  filaments 
present  a  dilatation  resembling  the  head  of  the  spermato- 
zoon at  both  ends  of  the  delicate  fiber  which  corresponds 
to  the  tail.  This  character  I  have  never  seen  in  sperma- 
tozoa, although  I  have  twice  met  with  instances  where 
two  specimens  were  united  end  to  end  (like  Craniodidymic- 
cephalopagic  monsters)  by  their  cephalic  extremities. 

The  clinical  importance  of  the  appearance  of  Spermato- 
zoa in  the  urine  has  been  greatly  overestimated,  since 
they  are  often  necessarily  present  in  the  urine  of  perfectly 
healthy  males,  and  only  indicate  the  occurrence  of  a  sem- 
inal emission,  whether  by  coitus  or  otherwise,  some  of 
the  spermatic  fluid  always  adhering  to  the  walls  of  the 
urethra  and  being  washed  out  in  the  next  succeeding 
or  subsequent  efforts  at  micturition  ;  so  that  only  when 
these  bodies  are  constantly  found  in  the  renal  secretion 
does  their  presence  become  a  symptom  worthy  of  attention. 
It  is  probable  that  the  disease  called  spermatorrhoea, 
fancied  attacks  of  which  provide  such  a  fruitful  harvest  to 
advertising  quacks  and  charlatans,  is  extremely  rare,  if 
indeed  it  exists  as  an  independent  affection ;  for,  as  re- 
marked by  Dr.  Beale,  "The  secretion  of  the  testicle,  like 
that  of  other  glands,  must  from  time  to  time  escape  ;  and 
when  it  is  formed  in  undue  quantity  and  discharged  too 
frequently,  it  is  usually  but  one  of  a  train  of  symptoms 
dependent  upon  changes  in  the  general  health."  The  de- 
tection of  spermatozoa  in  the  urine  may  sometimes  give 
a  valuable  hint  as  to  the  origin  of  obscure  cases  of  dys- 
pepsia and  general  debility,  in  excessive  masturbation,  as, 
for  instance,  when  the  morning  urine  of  several  days  in 


102  MEDICAL    MICROSCOPY. 

succession  is  found  to  be  loaded  with  this  deposit;  and,  on 
the  other  hand,  a  microscopist  may  occasionally  render 
good  service  to  one  class  of  hypochondriacs,  by  proving  to 
them  that  their  water  passed  during  the  day  at  least  is 
quite  free  from  seminal  fluid. 

The  detection  of  spermatozoa  in  the  urine  of  females 
can  lead,  of  course,  to  only  one  obvious  conclusion, 
although  the  greatest  caution  must  be  exercised  in  ex- 
pressing any  opinion,  always  bearing  in  mind  the  possi- 
bility of  error  from  accidental  admixture  of  the  masculine 
secretion  outside  of  the  body.  A  distinguished  physician 
of  this  city  was  perfectly  astounded  on  being  informed 
that  a  specimen  of  urine  (from  a  young  girl  supposed  to 
be  laboring  under  a  totally  different  affection)  which  he 
had  sent  to  me  for  examination  contained  numerous  sper- 
matozoa, and  could  only  be  convinced  of  the  fact  (so  in- 
credible did  it  seem,  in  view  of  the  patient's  social  posi- 
tion) by  an  ocular  demonstration.  For  methods  of 
Medico-Legal  investigation  in  regard  to  spermatozoa, 
consult  Chapter  XIV. 

In  the  management  of  so-called  spermatorrhoea,  when, 
as  is  usually  the  case,  the  evacuations  that  so  terrify  the 
patient  (whose  imagination  is  generally  filled  with  the 
anticipations  of  miserable  life  and  horrible  death  pictured 
in  the  detestable,  lying  advertisements  of  quacks  and 
their  still  viler  and  more  deceitful  books)  do  not  occur 
more  than  three  or  four  times  a  week  in  adults  of  average 
vigor,  moral  treatment,  consisting  of  a  full,  plain,  and 
clear  exposition  of  the  physiological  facts  in  regard  to  the 
reproductive  function,  will  often  be  found  sufficient,  pro- 
vided the  habit  of  masturbation  is  abandoned.  In  those 
comparatively  rare  cases  where  active  remedial  measures 
are  required,  Bromide  of  potassium,  in  doses  of  twenty 
grains  at  bedtime,  or  decoction  of  Dulcamara,  of  which  a 


URINE—MUCUS,  SPERMATOZOA,  ETC.  103 

wineglassful  may  be  taken  three  times  daily,  will  often 
prove  of  great  service. 

Should  the  Light  and  flocculent  deposit  be  found  to 
contain  neither  mucus  nor  spermatozoa,  soriie  form  of 
vegetable  growth,  consisting  either  of  Bacteria,  Vibri- 
ones,  or  Torulae,  will  generally  be  detected.  One  or 
more  of  these  various  fungi  (or  different  forms  of  the 
same  fungus)  always  grow  in  putrefying  urine,  and  are 
sometimes  found  in  that  fluid  directly  after  its  emission ; 
indeed,  according  to  Dr.  Beale  (Kidney  Diseases  and 
Urinary  Deposits,  3d  edition,  p.  322),  "they  are  some- 
times developed  in  urine  before  it  has  left  the  bladder." 
In  decomposing  urine,  examined  under  a  power  of  about 
200  diameters,  when  the  field  is  strongly  illuminated,  we 
may  perceive  a  great  number  of  very  delicate  lines,  from 
Y^nnr  to  -g-tfVo-  of  an  inch  in  length,  most  of  which,  when 
attentively  examined,  will  be  seen  to  exhibit  active 
and  constant  movements  ;  these  are  generally  associated 
Yibriones  and  Bacteria ;  or,  again,  we  may  discover 
numerous  rounded  cells  about  the  size  of  a  red  blood  cor- 
puscle, but  of  a  bluish  tint  and  fatty  luster,  sometimes 
single,  but  often  united  in  chains  of  three,  four,  or  more, 
such  chains  being  generally  curved  and  occasionally 
branched,  and  constituting  the  Torula  cerevisiae,  or  yeast- 
plant.  (See  Fig.  21.) 

According  to  M.  Davaine  (quoted  in  the  Pathologic 
Generale  of  E.  Bouchut,  Paris,  1868),  who  has  spent  much 
time  in  the  study  of  these  minute  bodies,  the  organisms 
which  appear  in  decomposing  solutions  of  animal  matter, 
such  as  infusion  of  beef,  urine,  etc.,  and  which  he  denomi- 
nates Yibrioniens,  may  be  classified  as  follows  : 


104  MEDICAL  MICROSCOPY. 

1.  Filaments  straight  or  bent,       2.  Filaments  twisted  in  a  spiral 

but    not    twisted     into    a  form. 

spiral. 

a.  b. 

Moving  spontaneously.      Immovable. 

(3. 

Eigid.          Flexible. 
Bacterium.       Vibrio.        Bacteridum.        Spirillum. 

In  many  specimens  of  urine,  all  four  of  these  organisms 
may  be  discovered,  and  sometimes  in  warm  weather,  ren- 
der the  fluid  opalescent  and  form  a  dense  sediment,  after 
a  day  or  two  of  repose.  The  subject  of  their  origin  is  one 
of  great  interest ;  and  unless  we  accept  the  theory  of  the 
Heterogenists  (Pouchet,  Pennetier,  Mantegazza,  and  now 
Charlton  Bastian)  accounting  for  them  by  the  doctrine  of 
spontaneous  generation,  it  seems  difficult  to  explain  their 
occurrence  in  freshly-voided  urine  without  admitting  that 
their  spores  have  previously  existed  in  the  blood  and 
been  eliminated  by  the  kidneys.  Much  more  extended 
observations,  however,  are  required  upon  this  abstruse 
subject,  for  whose  further  consideration  the  reader  is  re- 
ferred to  Chapter  IX.,  On  the  Examination  of  Blood. 

The  appearance  of  Torula — under  which  head  is  in- 
cluded Hassal's  "sugar  fungus"  (Transactions  of  the 
Royal  Medical  and  Chirurgical  Society  for  1853) — and  the 
Peniciltium  Glaucum,  probably  a  later  stage  of  both  the 
"  Yinegar-plant"  and  of  the  Oidium  lactis,  when  it  takes 
place  within  a  day  or  two  after  the  fluid  is  passed,  some- 
times indicates  the  existence  of  diabetes,  and  should 
always  suggest  to  the  physician  a  careful  application  of 
the  test  for  sugar,  although,  as  stated  by  Dr.  Roberts,  it 
may  grow  even  to  full  fructification  without  our  being 
able  to  detect  any  saccharine  matter  by  chemical  reagents. 
The  best  method  for  a  student  to  become  familiar  with  the 
appearance  of  the  yeast-plant  (see  Fig.  21)  is  to  examine 


URINE— MUCUS,  SPERMATOZOA,   ETC.  105 

a  minute  portion  of  common  brewers'  yeast  upon  a  irlass 
slide,  with  a  power  of  from  200  to  400,  and,  if  lie  has 
lime,  to  watch  the  growth  of  thn  plant  in  the  manner 
directed  by  Griffiths  and  Hen  fry  in  the  Mien  nrrap  hie  Dic- 
tionary, p.  746.  They  state  that  a  drop  of  fresh  wort, 
having  been  covered  with  a  thin  glass  whose  edges  were 
cemented  down  to  prevent  evaporation  (as  may  readily  be 
done  with  the  cement  described  on  p.  44),  exhibited 
numerous  torula  cells,  a  few  of  which  when  carefully  ex- 
amined for  about  three  hours  underwent  the  following 
changes:  at  first  the  globules  or  cells  enlarged  until  they 
attained  a  certain  size  ;  next,  after  a  short  interval  of  repose, 
there  took  place  a  projection  of  some  point  of  the  cell  wall, 
which  first  appeared  as  a  little  point-like  bud,  afterward 
becoming  larger  and  larger,  until  at  last  a  new  cell  of  the 
size  of  the  parent  cell  was  formed.  (See  Fig.  21.)  These 
changes  can  be  readily  seen  with  a  power  of  200  diam- 
eters, but  for  the  investigation  of  minute  fungi  in  general 
a  much  greater  amplification  is  required.  Indeed,  Dr.  Beale 
states  that  "  these  and  all  other  fungi  in  their  earliest  and 
simplest  condition  appear  as  minute  sporules,  less  than 
1 0  0*0  0  0  of  an  inch  in  diameter.  Such  very  minute  germs 
can  only  be  seen  with  the  aid  of  the  highest  magnifying 
powers, — the  -fa  and  ^-;  and  it  need  scarcely  be  said  that 
no  special  characteristic  differences  which  would  justify 
any  one  in  determining  species  can  be  discerned." 

Among  the  rarer  forms  of  fungi  found  in  the  urine  may 
be  mentioned  the  Sarcina  ventriculi,  which  has  now  been 
detected  by  a  sufficient  number  of  skilled  microscopists  to 
render  certain  its  occasional  existence  in  the  renal  secre- 
tion. The  characters  of  this  plant  (Fig.  22)  will  be  found 
described  in  Chapter  XI.  Dr.  Roberts  (Urinary  and 
Renal  Diseases,  Philadelphia  reprint,  1866,  p.  126) 
states  that,  although  Welker  considers  it  different  from 
the  Sarcina  of  the  stomach,  on  account  of  the  component 

10 


106  MEDICAL  MICROSCOPY. 

particles  as  well  as  the  aggregated  masses  being  of 
smaller  size,  it  is  probably  the  same  fungus.  The  growth 
is  usually  associated  with  vesical  catarrh,  pain  in  the 
back,  or  other  symptoms  of  irritation  of  the  kidneys  and 
bladder. 

According  to  Dr.  Beale,  benzoic  acid  may  occur  as  a 
light  flocculent  deposit  in  some  rare  cases  of  gout,  and  is 
supposed  to  result  from  the  decomposition  of  hippuric 
acid.  He  also  states  that  Kiihne  maintains,  in  jaundice 
it  escapes  unchanged  (after  ingestion)  by  the  kidneys, 
instead  of  being  converted  into  hippuric  acid,  as  occurs  in 
health. 


CHAPTER   Y. 

EXAMINATION   OP   URINE. 

Dense  and  Opaque  Deposits  Occupying  Considerable  Bulk. 
U rates.  Phosphates,  and  Pus. 

IN  the  investigation  of  a  dense  and  opaque  deposit  let 
fall  from  the  urine,  it  becomes  of  importance  to  decide 
whether  any  albumen  exists  in  the  fluid,  in  which  case  the 
sediment  probably  consists  of,  or  contains,  pus.  A  small 
quantity  of  the  liquid  should  therefore  be  tested  with  heat 
and  nitric  acid  as  directed  on  page  68,  after  which  a  speci- 
men of  the  sediment  should  be  placed  upon  a  slide,  cov- 
ered with  a  thin  glass,  and  examined  with  a  power  of  200 
diameters,  as  advised  on  page  69.  It  will  probably  be 
found  to  be  either,  first,  simply  granular  or  amorphous,  in 
which  case  it  is  composed  of  Urates  or  phosphate  of 
lime ;  secondly,  consisting  of  prismatic  crystals,  the  Triple 
phosphates ;  thirdly,  of  Leucocytes  floating  in  a  slightly 
albuminous  liquid,  in  which  contingency  the  urine,  if  albu- 
minous, contains  pus;  or,  lastly,  it  may  be  made  up  of 
any  two  or  all  three  of  these  ingredients. 

When  a  specimen  of  amorphous  deposit  which  dissolves 
readily  on  heating  the  fluid,  and  hence  consists  of  Urates, 
is  examined  with  a  power  of  from  400  to  800  diameters,  it 
is  seen  to  be  composed  of  excessively  minute,  transparent 
globules  adhering  to  each  other,  often  forming  short  lines 
of  three  to  ten  particles,  and  thus  somewhat  resembling 
the  chains  of  spores  of  some  vegetable  growths.  Should 
any  doubt  about  their  true  nature  be  entertained,  it  may 

(107) 


108  MEDICAL   MICROSCOPY. 

be  set  at  rest  by  heating  the  urine  in  a  test-tube,  when 
the  deposit  of  unites  will  promptly  dissolve ;  or,  as  sug- 
gested by  Dr.  Golding  Bird,  by  placing  a  drop  of  the  tur- 
bid urine  in  a  watch-glass,  gently  warming  it,  as  soon  as 
it  becomes  clear  adding  a  drop  of  almost  any  acid  (prefer- 
ably hydrochloric),  and  then,  when  it  has  grown  quite 
cold,  examining  it  under  the  microscope,  when  the  amor- 
phous urates  before  seen  will  be  found  replaced  by  loz- 
enges of  uric  acid  (see  Chap.  VI.). 

These  deposits,  which  are  the  most  common  ones  let 
fall  by  urine,  often  occur  in  the  renal  secretion  of  persons 
in  excellent  health.  They  vary  in  color  from  white  or 
light  yellow  to  a  pink,  purplish,  dark  red,  or  even  brown- 
ish tint,  the  reddish  or  "  brick-dust"  deposit  being  perhaps 
the  most  frequent  and  the  one  from  which  they  derive 
their  name  of  "  Lateritious"  (later,  a  brick).  As  shown 
by  the  researches  of  Heintz  and  Bence  Jones,  they  consist 
of  uric  acid  in  combination  with  varying  amounts  of 
potassa,  soda,  ammonia,  and  sometimes  lime  and  magnesia. 
The  urate  of  ammonia,  wnen  pure,  crystallizes  in  delicate 
needles,  but  is  never  found  in  the  urine  in  this  form,  the 
slightest  trace  of  chloride  of  sodium  causing  it  to  become 
amorphous  and  also  greatly  increasing  its  solubility. 
Urate  of  soda  sometimes  occurs  in  the  urine  of  feverish 
patients,  and  in  that  of  children,  in  the  shape  of  small 
yellowish  globules  from  -g-^oTT  ^°  nnnr  °^  an  ^nc^  *n  diame- 
ter,  either  with  or  without  sharp,  spicular  crystals  pro- 
jecting from  their  surface.,  Such  crystals  are  believed  by 
Dr.  Beale  to  consist  of  uric  acid,  and  he  considers  they 
have  been  deposited  upon  the  surface  of  the  globules  after 
the  latter  are  formed  (see  fig.  13). 

A  deposit  of  urates  is  often  associated  with  other  saline 
ingredients,  especially  octahedral  crystals  of  the  oxalate 
of  lime.  These  are  sometimes  so  very  minute  that  they 
may  escape  detection,  unless  the  urates  are  removed,  as 


URINE—  URATES,  P/fOsr//.lTES,  AND    PUS.      109 

Dr.  Beale  advises,  by  the  addition  of  solution  of  caustic' 
potash;  and  it  is  stated  that  urates  may  be  decomposed 
into  oxalates  while  standing  undisturbed  outside  of  the 
body.  The  characteristics  of  oxalate  of  lime  and  of  uric 
acid,  also  a  common  impurity,  will  be  given  in  the  next 
chapter.  Another  adulteration  of  the  sediments  of  urates, 
not  unfrequently  met  with,  is  the  triple  phosphate,  easily 
recognized  by  its  large,  clear,  and  beautiful  crystals  as 
shown  in  Fig.  9. 

Too  much  importance  must  not  be  attached  to  the  occa- 
sional appearance  of  a  deposit  of  urates,  as  they  are  often 
observed  during  any  slight  derangement  of  health,  or  even 
in  the  total  absence  of  disease.  Most  persons  pass  urine 
which  lets  fall  a  small  amount  of  brick-dust  sediment, 
during  a  common  cold,  or  after  indulging  in  too  nitro- 
genous or  too  stimulating  a  diet.  Such  deposits  are 
often  habitual  in  patients  suffering  from  disease  of  the 
thoracic  viscera  to  such  an  extent  as  to  interfere  with  the 
circulation  of  the  blood ;  and  it  is  probable  that  passive 
congestion  of  the  liver,  and  slow  movement  of  the  blood 
through  the  hepatic  capillaries,  have  much  to  do  with  this 
production  of  the  salts. 

The  large  deposit  of  urates  which  sometimes  takes  place 
when  resolution  of  an  acute  inflammatory  disease,  such  as 
Rheumatism,  pneumonia,  scarlet  fever,  etc.,  occurs,  is  often 
called  "  critical"  and  looked  upon  as  a  favorable  indication 
of  speedy  recovery.  Such  eliminative  discharge  should  be 
promoted  by  the  administration  of  saline  diuretics,  for  ex- 
ample acetate  of  potash,  and  diluents,  such  as  broom, 
slippery  elm,  or  flaxseed  tea. 

If  the  dense  and  opaque  deposit  let  fall  from  non-albu- 
minous urine  does  not  dissolve  on  the  application  of  heat, 
it  consists  of  Triple  phosphate  (tribasic  phosphate  of  am- 
monia and  magnesia),  or  the  simple  phosphate  of  lime, 
either  crystallized  (stellar  phosphate)  or  amorphous.  On 

10* 


110 


MEDICAL  MICROSCOPY. 


examining  a  specimen  of  such  sediment  in  the  manner 
directed  on  page  69,  crystals  of  the  appearance  delineated 
in  Fig.  9  will  probably  be  met  with,  often  mingled  with 


FIG.  9. 


CRYSTALS  OF  TRIPLE  PHOSPHATES.*    (After  Roberts.)    X  200  Diameters. 

some  granular  phosphate  of  lime ;  cases  of  stellar  phos- 
phate being  comparatively  so  rare  that  they  are  prac- 
tically unimportant  to  the  general  practitioner,  especially 
as  this  form  has  not  been  definitely  associated  with  any 
particular  disease. 

*  The  student  should  be  apprised  that  this  figure  is  made  up  of 
well-defined  and  typical  examples  of  crystals  selected  from  many 
different  fields,  or  even  various  specimens  of  urine,  the  intention 
being  not  to  delineate  accurately  any  particular  field  of  view,  as  is 
attempted  in  Fig.  27,  but  to  exhibit  as  many  characteristic  forms 
as  possible.  A  similar  remark  is  applicable,  of  course,  to  most 
microscopic  drawings  representing  isolated  objects,  as,  for  instance, 
Figs.  14,  19,  20,  and  30,  in  this  volume. 


URTNE—  UR ATi:s,   /'//nsi'/f.\r/-:s.   AND    PUS.       \\\ 

As  will  be  seen  in  the  figure,  the  crystals  of  triple  phos- 
phate present  many  varieties  of  size  and  shape.  The 
ordinary  form  is  that  of  a  triangular  prism  with  beveled 
ends,  but  many  modifications  are  produced  by  the  ridges 
and  corners  of  the  crystals  bein.n-  planed  oft'  as  it  were,  so 
that  they  assume  hexagonal  or  other  polylateral  figures. 
In  urine  which  is  highly  alkaline  from  the  development  of 
ammonia,  penniform  crystals  may  often  be  observed  ap- 
parently produced  by  a  symmetrical  excavation  of  the  sides 
and  ends  of  the  prisms  (see  figure).  When  unmixed  with 
any  other  substance,  the  triple  phosphate  crystals  present  to 
the  naked  eye  a  pure  milk-white  appearance,  and  may  some- 
times be  recognized  in  this  way  almost  without  micro- 
scopic investigation.  This  sediment  is  insoluble  in  alkalies, 
freely  soluble  in  acids,  such  as  hydrochloric  and  nitric,  but 
yet  may  frequently  be  found  in  urine  which  is  feebly  acid 
in  its  reaction.  It  seldom  occurs  alone,  being  often  accom- 
panied by  urate  of  ammonia  and  uric  acid,  sometimes  by 
oxalate  of  lime,  and,  in  highly  alkaline  urine,  almost  always 
by  Leucocytes  and  granular  phosphate  of  lime  occasionally 
in  the  form  of  minute  dumb-bells.  Should  any  doubt 
exist  as  to  the  character  of  a  deposit  of  supposed  phos- 
phate of  lime,  it  may  generally  be  determined  by  dissolv- 
ing the  sediment  in  acetic  acid  and  testing  for  lime  with 
oxalate  of  ammonia. 

The  clinical  importance  of  phosphatic  deposit  in  the 
urine  has  long  been  a  matter  of  dispute,  and  even  yet  can- 
not be  said  to  have  become  definitely  settled.  According 
to  Dr.  Bence  Jones,  while  in  delirium  tremens  and  some 
other  forms  of  delirium  the  quantity  of  sulphates  in  the 
urine  is  often  increased,  that  of  phosphatic  salts  is  sim- 
ilarly diminished ;  in  acute  inflammatory  affections  of  the 
nervous  system  the  total  amount,  both  of  sulphates  and 
of  earthy  and  alkaline  phosphates,  was  found  to  be  aug- 
mented; but,  as  remarked  by  Dr.  Beale,  it  is  very  im- 


112  MEDICAL  MICROSCOPY. 

portant  to  make  sure  that  the  superabundance  of  phos- 
phatic  salts  eliminated  by  the  renal  secretion  has  not 
really  entered  the  body  in  the  food  of  the  patient,  espe- 
cially as  it  is  by  no  means  improbable  that  a  part  of  the 
relatively  small  proportion  actually  manufactured  in  the 
system  is  a  product  of  muscular  disintegration,  since  Dr. 
Hammond  has  shown  that  active  exertion  largely  in- 
creases the  amount  of  phosphates  in  the  urine.  In  mol- 
lities  ossium,  where  the  earthy  matter  of  bones  is  ab- 
sorbed, an  actual  excess  of  phosphate  of  lime  generally 
occurs ;  and  it  is  probable  that  similar  deposits  take  place 
during  the  absorption  of  large  quantities  of  provisional 
callus  in  extensive  fractures,  and  give  rise  to  the  vesical 
irritation  not  uncommon  in  patients  so  situated. 

When  the  Triple  phosphate  is  found  deposited  from  acid 
or  neutral  urine,  and  occurs  in  small  quantities,  it  often 
indicates  only  a  functional  disturbance  of  the  stomach,  and 
is  accompanied  by  many  dyspeptic  symptoms,  such  as 
irregular  appetite,  irritability  of  the  stomach,  emaciation, 
extreme  restlessness,  and  peevishness  of  disposition. 
Such  urine  is  often  rich  in  urea  and  exhibits  this  sediment 
after  the  patient  has  been  subjected  to  some  unusual  men- 
tal or  physical  exertion.  If  triple  phosphate,  either 
alone  or,  what  is  more  common,  associated  with  the  phos- 
phate of  lime,  is  let  fall  abundantly  from  alkaline,  ammo- 
niacal,  or  rather  fetid  urine,  it  generally  indicates  serious 
disease  of  the  spinal  cord  or  some  organic  affection  of  the 
urinary  apparatus,  the  latter  complaints  being  distinguished 
by  the  history  and  general  symptoms.  This  kind  of  change 
in  the  urine  seems  to  follow  the  infliction  of  injuries  upon 
any  portion  of  the  spine,  such  as  falls,  blows,  strains,  etc., 
without,  as  observed  by  Brodie,  being  connected  with  the 
injury  of  any  particular  locality  (whether  in  the  lumbar, 
dorsal,  or  cervical  regions),  and  is  then  supposed  to  result 
from  the  loss  of  vitality  in  the  bladder,  permitting  the 


URINE—  URATJSS.  PffOSPffATBS,   AND    /'t'S.       n;j 

merely  chemical  forces  to  come  into' play.  It  is,  however, 
suggested  by  some  authors  that  the  vesical  mucus  under- 
going a  change  so  as  to  act  as  a  ferment  may  cause  the 
production  of  carbonate  of  ammonia  from  the  urea ;  this 
condition  is  very  apt  to  be  present  in  cases  of  paraplegia, 
as  well  as  in  those  of  irritation,  mechanical  or  otherwise, 
of  the  bladder.  For  distinguishing  these  different  morbid 
states  Dr.  Golding  Bird  gives  the  following  formula: 
"When  the  presence  of  a  deposit  of  phosphates  is  inde- 
pendent of  organic  disease,  it  is  most  abundant  in  the 
urine  passed  in  the  evening  (urine  of  digestion),  and  ab- 
sent, or  replaced  by  uric  acid  or  urates,  in  the  morning 
(urine  of  the  blood),  the  urine  being  always  of  a  tolerably 
natural  color,  never  below  and  often  above  the  mean  den- 
sity. When  the  presence  of  phosphatic  salts  depends  on 
the  irritation  of  a  calculus  or  of  organic  mischief  in  the 
urinary  passages,  the  urine  is  pale  and  wheylike,  of  a 
density  below  the  average,  often  considerably  so,  and  the 
earthy  deposit  is  nearly  equally  abundant  in  the  night  and 
morning  urine."  According  to  the  same  lamented  author, 
cases  sometimes  occur  in  which  a  deposit  of  large  quanti- 
ties of  phosphate  of  lime  occurs  daily  for  many  years 
without  serious  result,  a  circumstance  which  he  attributes 
to  its  secretion  in  vesical  mucus,  instead  of  its  being  a 
pathological  formation  of  the  kidneys. 

In  the  management  of  cases  of  dyspepsia  accompanied 
with  heavy  deposits  of  phosphatic  salts  in  the  urine  much 
benefit  is  often  to  be  derived  from  small  doses  of  the  min- 
eral acids,  especially  Nitromuriatic,  given,  if  the  stomach 
will  bear  it,  in  some  bitter  infusion,  as  of  gentian,  or  in 
combination  with  nux  vomica ;  gastric  irritability  being 
first  allayed  by  Nitrate  of  bismuth  or  hydrocyanic  acid, 
and  constipation  of  the  bowels  overcome  by  aperient 
doses  of  rhubarb  or  castor  oil.  If  the  digestion  be  feeble, 
pepsin  wine  often  affords  important  aid ;  and  should  great 


114  MEDICAL  MICROSCOPY. 

irritability  of  the  nervous  system  complicate  the  case,  a 
pill  of  valerianate  of  zinc  and  extract  of  hyoscyamus,  or 
the  cautious  use  of  bromide  of  ammonium,  will  frequently 
prove  beneficial.  The  hypodermic  use  of  morphia  has 
also  been  found  exceedingly  advantageous.  When  the 
phosphatic  deposit  as  well  as  the  nervous  symptoms  can  be 
traced  to  some  shock  of  the  spinal  cord,  this  latter  method 
of  employing  opiates  is  exceedingly  valuable,  and  must  be 
combined  with  counter-irritation  along  the  back,  as  of 
iodine,  blisters,  tartar  emetic,  etc.,  and  constitutional  treat- 
ment with  a  view  of  building  up  by  every  possible  means 
the  general  health.  In  cases  of  simple  irritation  of  the 
bladder  without  the  development  of  actual  cystitis  (as 
well  as  in  the  chronic  stage  of  the  latter  affection)  the 
vegetable  tonics  associated  with  iron,  particularly  in  the 
form  of  tinctura  ferri  chloridi,  in  conjunction  with  the 
daily  washing  out  of  the  bladder  by  injections  of  warm 
water  through  the  double  canula,  should  be  employed. 
Dr.  Beale  remarks  that  "alkalies,  as  Dr.  Owen  Rees  was 
the  first  to  show,  undoubtedly  do  good  in  some  of  these 
cases  of  phosphatic  urine,  probably  by  their  action  in  pro- 
moting the  normal  chemical  changes  in  the  blood  rather 
than  by  direct  action  upon  the  kidney  or  any  part  of  the 
genito-urinary  mucous  membrane." 

Carbonate  of  lime  occurs  rarely  as  a  deposit  from 
human  urine,  and  is  generally  in  small  quantity  (see 
Chapter  VI.). 

If  now  the  specimen  of  dense  and  opaque  deposit  we 
are  examining  is  let  fall  from  an  albuminous  urine  and  yet 
contains  neither  red  blood  corpuscles  nor  tube-casts,  but  is 
composed  of  spherical  cellular  elements  varying  in  different 
specimens  from  ^^  to  -3-^-5-  of  an  inch  in  diameter,  we 
may  conclude  that  it  is  pus,  and,  as  a  further  proof,  will 
probably  find  that  if  a  fluidrachm  of  the  sediment  is  mixed 
with  an  equal  bulk  of  liquor  potassa  in  a  test-tube  it  will 


URINE—  U RATES,  PHOSPHATES,  AND  PUS.       H5 

become  transparent  and  so  gelatinous  and  tenacious  that 
the  vessel  may  often  be  inverted  without  the  evacuation 
of  its  contents. 

As  stated  when  speaking  of  mucus  in  the  urine,  the  cor- 
puscles of  pus  (Leucocytes)  vary  in  size  with  the  specific 
gravity  of  the  fluid  in  which  they  float;  except  when 
largely  expanded,  they  resemble  the  white  blood  cells,  but 
when  quite  distended  and  about  y^Viy  °f  an  inc^  i°  diam- 
eter their  aspect  becomes  similar  to  that  shown  in  the  ac- 
companying figure,  drawn  from  specimens  of  Leucocytes 
(lying  in  urine  of  the  specific  gravity  of  1010),  in  most  of 
which  the  active  revolving  movements  of  the  contained 
molecules  were  very  distinct. 

Fia.  10. 


Pus  CORPUSCLES  (LEUCOCYTES),  which,  in  urine  of  sp.  gr.  1010,  have  assumed 
the  SALIVARY  CORPUSCULAR  FORM. 

a.  Magnified  220  Diameters,     b.  Magnified  1200  Diameters. 

The  detection  of  Leucocytes  in  urine  is  seldom  attended 
with  much  difficulty,  but  should  any  (Joubt  arise  they  may 
be  readily  recognized  by  the  following  reactions.  If  a 
drop  of  very  dilute  acetic  acid  is  placed  upon  the  slide  at 
the  margin  of  the  cover  and  allowed  to  flow  beneath  it, 
some  of  the  corpuscles  (if  Leucocytes)  will  soon  show  one, 


116  MEDICAL  MICROSCOPY. 

two,  or  three  bright  points  in  their  interior,  while  if  the 
operation  is  observed  with  a  high  objective  or  a  lower  one 
of  superior  excellence,  the  delicate  cell  wall  of  extreme 
tenuity  may  be  seen  surrounding  these  nuclei,  until  after 
a  time  it  bursts  and  disappears.  With  an  ordinary  \  inch 
lens,  however,  it  is  often  extremely  difficult  to  demon- 
strate this  membranous  envelope,  and  the  student  must 
frequently  be  satisfied  with  seeing  that  in  many  cases  two 
or  three  granules  have  taken  the  place  of  a  single  Leuco- 
cyte. By  adding  solution  of  aniline,  as  directed  in  Chap- 
ter II.,  in  sufficient  quantity  to  dilute  the  urine  and  so  dis- 
tend the  corpuscles  gradually,  at  the  same  time  that  their 
nuclei  and  cell  walls  are  tinted,  we  may  often  obtain,  even 
with  objectives  of  low  power,  a  fine  view  of  the  enlarged 
Leucocytes,  as  shown  in  Fig.  10,  a.  Another  remarkable 
characteristic  sometimes  observed  in  the  Leucocyte  of  the 
urine  is  the  amoeboid  movement  (see  Chapter  IX.)  which, 
as  remarked  above,  is  chiefly  to  be  seen  when  the  corpus- 
cles are  effused  on  the  vesical  mucous  membrane,  and 
serves  to  indicate  (although  it  does  not  prove)  that  their 
origin  is  not  renal.  These  movements  are  much  more 
active,  as  has  been  shown  by  Schultze  in  his  Archives, 
when  the  specimen  is  warmed  upon  the  slide  to  a  little 
above  the  normal  temperature  of  the  body,  and  are  espe- 
cially noticeable  in  hot  weather,  doubtless  because  the 
urine  does  not  become  chilled  so  as  to  check  their  activity. 
According  to  Dr.  Beale,  "  pus"  corpuscles  are  very  com- 
mon in  the  urine  of  males  somewhat  advanced  in  life  while 
in  good  health ;  and  even  when  the  flow  is  abundant, 
amounting  to  several  ounces  every  twenty-four  hours,  the 
debilitating  effects  seem  much  less  marked  than  from  a 
similarly  profuse  suppuration  occurring  elsewhere.  The 
amount  and  character  of  the  pain,  taken  in  connection 
with  the  greater  or  less  irritability  of  the  individual  tem- 
perament, are  often  invaluable  guides  to  the  extent  of 


URINE—  UK  A  TKS,  PI10SPII  .1  77/N.   AND  PUS.       H7 

structural  change  which  is  going  on.  As  before  mentioned 
(pa  ire  85),  when  pus  corpuscles  are  derived  from  the 
Madder  they  are  generally  mingled  with  crystals  of  triple 
phosphate  and  with  granules  and  spherules  of  phosphate 
of  lime,  which  alone  sometimes  form  a  deposit  to  the 
naked  eye  strongly  resembling  pus,  as  in  the  following 
example:  John  O'Brien,  a  soldier,  aged  25,  a  patient 
under  the  care  of  Dr.  T.  G.  Morton,  in  the  Upper  Surgical 
Ward  of  the  Pennsylvania  Hospital,  where  he  was  ad- 
mitted December  2(,>,  18C^>,  was  affected  with  a  very  dense 
stricture  of  the  urethra,  traumatic  in  its  origin,  to  relieve 
which,  as  it  had  already  been  operated  upon  unsuccess- 
fully by  dilatation,  it  was  proposed  to  perform  perineal 
section.  Since,  however,  the  man's  urine  let  fall  a  light- 
yellowish  sediment  whose  aspect  exactly  resembled  pus, 
Dr.  Morton  suspected  that  a  burrowing  abscess  of  the  per- 
ineum, the  result  of  the  old  injury,  might  exist,  which  of 
course  would  interfere  with  the  success  of  the  operation  ; 
and  he  therefore  directed  a  specimen  of  the  morning  urine 
to  be  sent  to  me  for  investigation.  Examining  £  of  a 
square  inch  of  urinous  film,  as  recommended  on  p.  70,  I 
discovered  that  the  deposit  was  chiefly  composed  of  small 
crystals  of  triple  phosphate  with  a  few  epithelial  cells  and 
not  more  than  ten  or  twelve  Leucocytes.  On  receiving 
this  report  the  attending  surgeon  determined  to  perform 
the  operation,  which  was  entirely  successful,  no  suppu- 
rating unhealthy  tissue  existing  to  interfere  with  the  heal- 
ing of  the  wound. 

In  cities,  and  especially  sea-port  towns,  one  of  the  most 
common  causes  of  pus  in  the  urine  of  males  is  gonor- 
rhoea, and  this  source  may  generally  be  detected  by  careful 
examination  of  the  patient,  compressing  the  urethra  from 
behind  forward  in  such  a  way  as  to  cause  any  contained 
fluid  to  exude  from  the  meatus  urinarius.  In  women  an 
ordinary  cause  of  purulent  deposit  in  the  urine  is  leumr- 

11 


118  MEDICAL   MICROSCOPY. 

rhcea,  the  Leucocytes  of  which  may  often  be  suspected 
from  their  association  with  the  tessellated  epithelium  of 
the  vagina  and  their  presumed  origin  rendered  certain  by 
further  investigation  of  the  case  (vide  Chapter  XII.). 

Suppuration  of  the  pelvis  of  the  kidney,  or  Pyelitis,  is 
generally  pointed  out  by  the  direct  signs  of  irritation  in 
the  lumbar  regions;  and  in  those  comparatively  rare  cases 
where  such  indications  are  absent,  the  diagnosis  must  be 
made,  if  at  all,  by  excluding  urethritis  and  cystitis,  as 
directed  above  and  on  page  85,. and  nephritis  by  the  his- 
tory of  the  case  and  the  absence  of  tube-casts.  Accord- 
ing to  Dr.  Roberts,  the  appearance  of  epithelium  from  the 
pelvis  and  infundibulum  affords  the  most  certain  indica- 
tion of  this  disease ;  these  cells  are  very  irregular,  being 
"spindle-shaped,  tailed,  three-cornered,  elongated,  rudely 
circular,  etc.,"  and  the  urine  is  generally  acid. 

The  bursting  of  an  abscess  from  pelvic  cellulitis  into 
the  urinary  passages  is  often  characterized  by  the  sudden 
appearance  of  a  large  quantity-of  pus  in  the  urine  after 
some  weeks  of  suffering  from  fever,  local  pain,  etc.,  but 
where  the  collection  of  pus  has  been  very  deep-seated  and 
slowly  evacuated  may  sometimes  give  rise  to  much  diffi- 
culty of  diagnosis.  Dr.  Bird  states  that  an  empyema  has 
been  known  to  find  its  way  to  the  kidney,  emptying  itself 
through  an  ulcerated  opening,  and  be  discharged  with  the 
urine. 

If  the  Leucocytes  of  pus  are  found  in  the  urine,  and  on 
examination  we  discover  a  fullness  or  a  smooth,  immovable 
tumor  in  the  lumbar  region,  especially  if  on  percussion  we 
are  able  to  mark  out  enlarged  kidney,  the  disease  is  proba- 
bly dilatation  of  one  of  these  organs.  According  to  Dr.  Fen- 
wick  (Guide  to  Medical  Diagnosis,  London,  1869,  p.  73), 
there  is  generally  tenderness  on  pressure,  and  the  patient 
complains  of  pain  in  the  loins,  thigh,  and  testis,  usually 
with  debility  and  occasional  night-sweats,  and  the  disease  is 


URINE—  URA  TES,  PIIosi'liA  TES,  A ND   P US.       \\\) 

generally  caused  by  stricture  of  the  urethra,  stone  in  the 
kidney,  tubercular  disease  of  the  kidm-y,  and  in  the  female 
by  cancer  of  the  uterus.  If  pus  of  renal  origin  is  found 
in  the  urine  without  indications  of  dilated  kidney,  but  in  a 
patient  with  pulmonary  tuberculosis,  the  disease  is  proba- 
bly tubercle  of  the  kidneys.  Sometimes,  in  addition  to  the 
Leucocytes,  broken-down  cheesy  masses  may  be  seen,  to 
gether  with  a  large  amount  of  granular  debris  (see  Chap- 
ter VI.). 

Independent  of  tubercular  deposit,  the  formation  of  pus 
may  take  place  in  the  kidney  from  ordinary  phlegmonoid 
inflammation  encling  in  circumscribed  abscess,  from  py- 
aemia, or  from  renal  embolism.  The  first  is  generally 
accompanied  by  pain,  fever,  haematuria,  and  successive, 
often  regular,  rigors  ;  when  pus  is  fully  formed,  the  abscess 
generally  bursts  into  the  pelvis  and  is  discharged  by  the 
ureter,  but  occasionally  it  is  evacuated  into  the  colon  or 
duodenum,  the  cavity  of  the  peritoneum,  the  thorax,  or 
through  the  posterior  wall  of  the  abdomen.  The  treatment 
can  consist  of  but  little  more  than  the  hypodermic  use  of 
morphia,  and  injections  to  prevent  constipation.  When  in- 
dications of  pointing  in  the  lumbar  regions  appear,  poul- 
tices should  be  applied  and  the  matter  evacuated  early,  to 
prevent  burrowing ;  but  when  the  suppuration  is  caused  by 
impacted  calculi,  other  abscesses  are  apt  to  succeed  and 
wear  out  the  patient.  The  occurrence  of  secondary  ab- 
scesses of  pyaemia  in  the  kidneys  is  less  frequent  than  in 
the  lungs  or  liver,  but  may  be  suspected  in  that  disease 
if  pain  and  soreness  of  the  lumbar  regions  come  on  with 
albuminous  urine  in  the  course  of  the  affection.  The 
impaction  of  small  fibrinous  masses  from  the  aortic  and 
mitral  valves  in  endocarditis  is  not  very  uncommon,  but, 
unless  the  emboli  are  large,  can  rarely  be  diagnosti- 
cated during  life.  The  first  effect  of  obstructing  an  artery 
of  considerable  size  in  the  kidney  is  to  produce  intense 


120  MEDICAL  MICROSCOPY. 

hypereemia  of  the  surrounding  parts  and  sanguineous 
effusion,  so  that  if  during  or  soon  after  an  attack  of  endo- 
carditis a  patient  experiences  sudden  and  severe  pain  in  the 
kidney,  and  the  next  day  red  and  white  corpuscles  in  nor- 
mal proportions  are  found  in  the  urine,  a  strong  suspicion 
of  embolism  may  be  entertained. 

The  management  of  patients  affected  with  chronic  or 
subacute  cystitis,  sometimes  called  catarrh  of  the  bladder, 
is,  according  to  Dr.  Beale,  often  unsuccessful  because 
not  properly  persevered  in  and  understood,  it  frequently 
happening  that  a  case  which  has  been  getting  worse  on 
alternate  weeks  of  Buchu,  Uva  ursi,  Pareira  brava,  acids, 
and  alkalies,  will  rapidly  improve  under  a  suitable  per- 
sistence of  dilute  mineral  acids  with  pepsin,  stimulants, 
simple  but  nutritious  food,  aided  by  country  or  sea  air  and 
exercise.  In  all  cases  where  the  pus  is  converted  into 
ropy,  mucus-like  masses  within  the  bladder,  that  viscus 
should  be  washed  out  by  injecting  warm  water  every  day 
or  two,  taking  care  not  to  produce  dangerous  distention 
by  throwing  in  too  much  fluid. 


CHAPTER  VI. 

EXAMINATION   OP    URINE. 

Scanty  Granular,  or  Crystalline  Deposits. 

('n/'j)ttxflcSj  Cancer  Cells,  Oxalate  of  Lime,  Uric  Acid,  Car- 
bonate of  Lime,  Cystine,  etc. 

IF  the  specimen  of  urine  we  are  invited  to  examine  has 
let  fall,  upon  standing  as  directed  in  Chapter  III.,  a  sedi- 
ment of  small  bulk  appearing  either  granular  or  crystalline 
to  the  naked  eye,  it  should  in  the  first  place  be  tested  for 
albumen  with  heat  and  nitric  acid  (see  p.  68) ;  and  if 
found  to  afford  a  coagulum  with  these  reagents,  its  deposit 
must  be  carefully  investigated  for  red  blood  corpuscles, 
which  will  probably  be  detected. 

The  ease  with  which  red  and  wnite  blood  corpuscles 
may  be  recognized  in  the  renal  secretion  depends  very 
much  upon  the  specific  gravity  of  that  fluid;  the  rapid 
almost  instantaneous  occurrence  of  ex-  or  eodosmosis 
through  the  cell  walls  of  the  corpuscles  greatly  modifying 
their  external  appearance.  Thus,  for  example,  in  urine  of 
high  specific  gravity  the  red  disks  will  often  be  found 
darker  in  color  than  natural,  and  "crenated"  (see  Fig.  6,  e} 
or  stellate,  from  the  wrinkling  of  their  cell  walls  as  the 
fluid  portion  of  their  contents  passes  out  into  the  denser 
liquid  (the  same  effect  being  produced  by  long  soaking,  in 
ordinary  urine),  while  the  white  blood  globules  are  opaque, 
spherical,  and  not  more  than  g^Vo"  °f  an  mc^  ^n  diameter. 
In  urine  of  a  density  approaching  1025  the  red  disks  (Fig. 
It)  and  white  globules,  if  specimens  are  examined  soon 

11*  (121) 


122  MEDICAL   MICROSCOPY. 

after  being  voided,  may  often  be  found  presenting  a  per- 
fectly normal  appearance  ;  but  should  the  urinary  secre- 
tion be  of  low  specific  gravity,  1010  or  less,  the  red  cor- 
puscles will  have  become  spherical,  colorless  from  the  ex- 
osmosis  of  their  hsemato-crystalline, — indeed,  almost  invisi- 
ble to  the  unpracticed  eye,  if  not  aided  by  a  very  superior 
lens  or  one  of  high  power,  unless  the  transparent  cell  walls 
are  colored  by  a  little  iodine  or  aniline  solution  (see  my 
paper  on  Blood  Stains,  Am.  Jour,  of  Med.  Sci.,  July, 
1869).  The  white  blood  corpuscles  or  Leucocytes  will  be 
found  nearly  double  their  ordinary  size,  varying  from 
Woo"  t°  TiVo  °f  an -inch  in  diameter,  and  showing  a  dis- 
tinct cell  wall  and  one,  two,  or  three  nuclei  (see  Fig.  10), 
around  which  revolve,  with  great  rapidity,  numerous  mole- 
cules,— in  fact,  presenting  all  the  characters  of  the  Salivary 
corpuscular  form  of  the  Leucocyte,  which,  like  the  alteration 
in  shape  of  the  red  disk,  has  apparently  been  produced  sim- 
ply by  the  distention  of  their  cell  walls.  These  changes  of 
shape  and  size,  as  the  density  of  the  circumambient  fluid  is 
altered,  will  generally  enable  us  to  distinguish  blood  cor- 
puscles from  the  spores  of  some  fungi  which  resemble 
them  under  low  powers ;  if  they  do  not,  the  urine  may 
be  set  aside  for  a  day  or  two,  when  the  spores  of  such  will 
manifest  themselves  by  germination.  Dr.  George  Harley 
describes  a  uni-  and  bi-maculated  appearance  observed  in  the 
red  blood  corpuscles,  which  , he  attributes  to  the  action  of 
the  saline  constituents  of  the  urine  in  which  they  floated. 
Supposing  now  that  the  deposit  has  been  found  to  con- 
sist of  or  contain  red  blood  corpuscles  with  Leucocytes,  it 
becomes  a  matter  of  importance  to  decide  from  what  por- 
tion of  the  genito-urinary  tract  these  take  their  origin. 
Since  the  hemorrhagic  elements,  no  matter  where  they 
are  effused,  present  the  same  characters,  it  is  obvious  that 
cases  must  occur  where  this  is  simply  impossible ;  but  in  a 
large  majority  of  instances  careful  attention  to  all  the  cir- 


I'  HIM-:  -BLOOD    CORPUSCLES,   ETC.  |-_>:; 


cumstanccs   will   enable  the   observer  to  reach  a  correct 
conclusion. 

A  very  important  element  in  forming  a  diagnosis  is  the 
seat  of  any  complaint  of  pain  or  soreness  by  the  patient, 
especially  if  the  history  of  the  case  refers  to  a  fall,  blow, 
or  strain  of  that  particular  part.  The  appearance  of  the 
blood  in  the  urine  likewise  guides  us  in  some  instances, 
being  generally  diffused  through  the  fluid  when  of  renal, 
and  (except  when  small  in  amount)  collected  in  coagula 
when  of  vesical  or  urethral  origin.  In  the  female  it  may 
be  necessary  to  draw  off  the  urine  with  a  catheter  for  the 
purpose  of  avoiding  contamination  by  uterine,  vaginal,  or 
hemorrhoidal  discharges.  (See  also  diagnostic  points  enu- 
merated on  page  85.) 

Should  we  succeed  by  the  considerations  suggested 
above  in  localizing  the  point  of  escape  of  the  red  corpus- 
cles, we  must  next  endeavor  to  make  sure  that  they  result 
from  true  hemorrhage.  If  they  come  from  an  effusion 
sufficient  in  amount  to  form  a  coagulum,  as  is  often  the 
fact  when  small  vessels  of  the  mucous  membrane  lining 
the  urethra,  bladder,  or  ureters  are  ruptured,  the  case 
presents  little  difficulty  ;  but  if  no  clots  be  formed,  we 
have  but  little  except  the  location  and  amount  of  pain,  as 
referred  to  on  page  85,  to  guide  us  to  a  correct  conclusion. 
Should  this  circumstance  direct  us  to  the  kidneys  as  the 
seat  of  morbid  action,  the  following  observations  quoted 
from  my  paper  in  Dr.  Hays'  Journal  for  January,  1870, 
may  be  useful  : 

"First.  When  the  red  blood  globules  very  largely  ex- 
ceed the  white  in  number,  approximating  to  the  proportion 
in  normal  blood,  it  is  probable,  as  intimated  above,  that 
rupture  of  some  small  vessels  has  taken  place,  and  the 
flow  of  blood  is  a  true  hemorrhage  from  the  kidney,  which 
may  be  produced  by  blows  across  the  loins  or  lacerations 
caused  by  angular  calculi.  This  opinion  will  be  further 


124  MEDICAL  MICROSCOPY. 

strengthened  if  a  thorough  search  fails  to  reveal  any  tube- 
casts,  and  if  the  albumen  as  coagulated  by  heat  and  nitric 
acid  is  no  more  than  should  exist  in  'an  amount  of  liquor 
sanguinis  corresponding  to  the  bulk  of  deposit  formed  of 
cell  walls  from  the  red  disks.  As  an  approximative  guide 
for  determining  this  last  point,  I  find  by  experiment  that  a 
fluidrachm  of  blood  stirred  up  in  two  fluidounces  of  water 
lets  fall,  on  standing  twelve  hours,  a  whitish  deposit  of 
fibrin  and  cell  walls,  measuring  about  two  fiuidrachms, 
and  that  a  portion  of  the  supernatant  liquid  tested  with 
heat  and  nitric  acid  yields  a  coagulum,  chiefly  albuminous, 
occupying  about  one-fourth  of  its  bulk. 

"Second.  When  in  Bright's  disease  the  white  blood  cor- 
puscles are  mingled  with  red  disks  in  a  proportion  exceed- 
ing one  twenty-fifth  of  the  latter,  my  observations  lead 
me  to  conclude  that  generally  the  patient  is  suffering  from 
an  acute  or  subacute  inflammation  of  one  or  both  kidneys, 
and  attended  with  danger  therefrom  more  or  less  serious, 
according  as  the  amount  of  corpuscular  elements  shows 
by  its  absolute  quantity  that  a  larger  or  smaller  portion  of 
the  kidney  is  inflamed.  If  the  albuminous  coagulum  pro- 
duced by  heat  and  nitric  acid  occupies  more  than  one-half 
the  fluid  tested,  and  many  times  exceeds  that  which  would 
be  furnished  by  the  liquor  sanguinis  corresponding  to  the 
blood  corpuscles,  an  extensive  inflammatory  disease  prob- 
ably exists,  unless  careful  microscopic  scrutiny  shows 
decided  fatty  degeneration  (and  consequent  loss  of  secre- 
tive power)  in  the  epithelium  of  the  uriniferous  tubules. 

"Lastly,  should  we  discover  on  examination  that  the 
white  blood  cells  (hitherto  designated  as  '  mucous  corpus- 
cles,' 'exudation  corpuscles,'  and  by  Dr.  Beale  'cells 
closely  resembling  pus  corpuscles,' — Microscope  in  Prac- 
tical Medicine,  p.  219)  pass  off  from  the  kidneys  with 
little  or  no  admixture  of  the  red  disks,  we  may  conclude 
that  a  chronic  inflammation  of  the  organs  exists  less 


UllIXl'     i; I. unit    CORPUSCLES^    I-.TC.  !•_>:> 

or  more  extensive  as  the  number  <>f  the  leucocytes  is 
smaller  or  greater  and  as  the  amount  of  fatty  degenera- 
tion, estimated  as  above  suggested,  is  serious  or  other- 
wise ;  for  my  researches  tend  to  show  that  the  one  cause 
of  albumen  in  the  urine  varies  inversely  as  the  other ;  that 
is,  if  in  a  given  ease  of  ISriidit's  disease  the  urine  con- 
taining say  one-fourth  of  its  bulk  of  coagulated  albumen 
after  boiling  shows  many  white  blood  corpuscles  with 
epithelial  cells  only  slightly  fatty,  and  another  specimen 
of  the  same,  collected  perhaps  two  months  afterward, 
exhibits  with  the  same  amount  of  albumen  few  leucocytes 
but  epithelium  containing  large  oil  globules,  we  may  con- 
clude that  (following  Dr.  Grainger  Stewart  in  his  classifi- 
cation on  the  basis  of  Virchow's)  we  have  to  deal  with 
the  First  or  Inflammatory  form  (involving  a  large  portion 
of  the  organs),  which  had  passed  from  stage  a,  that  of  In- 
flammation, to  stage  b,  that  of  Fatty  Transformation; 
many  cases,  however,  seem  to  run  a  much  more  favorable 
course,  the  pus  corpuscles  diminishing  in  number  without 
any  corresponding  advance  toward  fatty  degeneration 
in  the  epithelial  lining  of  the  tubules,  so  that  the  albumen 
slowly  decreases  in  quantity,  and  the  patient  regains  at 
least  a  comfortable  state  of  health,"  as  in  the  example  of 
X.  Y.,  quoted  on  page  77. 

The  diseases  to  which  an  occurrence,  from  hemorrhage, 
of  red  blood  corpuscles  in  the  urine  point  are — ulceration  or 
laceration  of  the  urethra,  which  will  generally  be  charac- 
terized by  the  local  symptoms  and  the  history  of  the  case ; 
mechanical  injuries  of  the  bladder,  either  external  from 
blows  across  the  pubis,  fracture  of  the  pelvis,  etc.,  or  in- 
ternal from  the  passage  of  instruments  or  from  the  angles 
of  a  calculus  ;  effusion  of  blood  may  likewise  take  place 
from  malignant  disease  of  the  bladder,  in  which  case  the 
so-called  cancer  cells  will  probably  be  found  at  some 
period  of  its  course.  Hemorrhage  from  the  ureters  is 


12G  MEDICAL  MICROSCOPY. 

almost  always  produced  by  the  passage  of  a  small  stone, 
and  the  agonizing  pain  suffered  is  usually  characteristic 
of  its  seat.  Hemorrhage  from  the  kidney  (without 
Bright's  disease)  is  generally  caused  by  falls  or  blows 
upon  the  loins  or  by  calculi  imbedded  in  the  renal  sub- 
stance and  occupying  the  pelvis;  the  latter  affection  is 
particularly  to  be  suspected  if  a  flow  of  blood  and  severe 
pain  in  the  back  are  brought  on  by  rough  riding  or  the 
lifting  of  heavy  weights.  The  loss  of  blood  from  these 
various  causes  will  seldom  require  special  treatment,  but 
in  exceptional  cases  it  may  be  necessary  to  combine  the 
administration  of  gallic  acid,  ergot,  oil  of  turpentine,  or 
tincture  of  iron  with  remedies  suited  to  the  several 
affections. 

Hemorrhage  from  the  kidney  sometimes  occurs  in  en- 
teric fever,  in  rheumatism,  and  in  pneumonia,  and,  although 
generally  ceasing  in  a  few  days,  may  continue  until  it  pro- 
duces an  anemic  condition  of  the  system.  Intermittent 
ha3inaturia  is  sometimes  an  epidemic  disease  in  some  of 
our  Southern  States,  and  occasionally  proves  very  unman- 
ageable, although  usually  yielding  to  full  doses  of  quinine. 
(See  a  paper  by  S.  F.  Starkey,  M.D.,  in  the  New  Orleans 
Med.  and  Surg.  Journal  for  October,  1869.) 

Haematinuria  (false  haematuria)  is  a  name  applied  to 
the  condition  described  by  Yogel  and  other  authorities,  in 
which  the  haamatin  of  the  blood  escapes  in  the  urine  with- 
out red  blood  disks  being  present,  and  is  attributed  to 
the  dissolved  state  of  the  blood  in  pyaemia,  putrid  fevers, 
and  some  cases  of  scurvy  and  purpura. 

Should  the  specimen  of  urinary  deposit  be  found  to 
contain  great  quantities  of  rounded,  caudate,  and  spindle- 
shaped  cells,  with  large  nuclei  (see  Chap.  XY.)  somewhat 
resembling  the  epithelium  from  the  ureter  depicted  in  Fig. 
6,  a  MALIGNANT  GROWTH  situated  in  some  part  of  the 
urinary  apparatus  may  be  suspected,  although,  on  account 


URINE— BLOOD   CORPUSCLES,  ETC.  127 

of  the  great  similarity  borne  by  the  histological  elements 
of  the  heterologous  formation  to  epithelial  cells  above 
alluded  to,  no  positive  diagnosis  can  be  made  from  iso- 
lated specimens;  when,  however,  as  occasionally  happens, 
small  portions  of  the  cancerous  mass  slough  off  and  are 
visible  in  the  urine,  the  detection  of  such  cells,  imbedded 
in  stroma,  will  often  enable  us  to  arrive  at  a  definite  con- 
clusion, especially  when  a  history  of  the  case  confirms 
such  a  view  of  its  character.  The  general  appearance  of 
cancerous  deposit  in  the  urine  is  said  to  be  that  of  a  thick, 
dirty,  blood-stained  sediment,  containing  abundance  of 
blood  corpuscles  mixed  with  spindled-shaped,  oval,  and 
irregular  cells,  pus  corpuscles  being  wholly  or  nearly  ab- 
sent. Dr.  Roberts  further  remarks  :  "  In  cancer  of  the 
kidney  no  help  to  the  diagnosis  must  be  expected  from  the 
character  of  the  urinary  deposit."  Dr.  Beale  states  that 
he  has  seen  several  cases  where  cancer  of  the  bladder  was 
detected  for  the  first  time  by  the  microscopical  examina- 
tion of  the  urine,  which  let  fall  a  deposit  of  a  dark-brown 
color  (resembling  blood  as  it  occurs  in  acid  urine)  found 
to  consist  chiefly  of  cancer  cells ;  he  also  describes  the  ap- 
pearances presented  by  a  specimen  of  gelatinous-looking 
matter  which  had  been  passed  by  a  patient  of  Sir  William 
Fergusson's  suffering  with  some  disease  of  the  bladder,  the 
exact  nature  of  whose  case  had  been  the  subject  of  dispute, 
as  follows  :  "  Upon  treating  a  fragment  of  it  with  a  little 
glycerin  and  water  and  subjecting  it  to  examination  with 
a  power  of  two  hundred  diameters,  I  had  no  difficulty  in 
making  out  loops  of  capillary  vessels,  covered  with  a 
thick  layer  of  cancer  cells.  The  specimen  presented  the 
usual  appearances  which  distinguish  a  cancerous  tumor 
rapidly  growing  into  a  hollow  viscus,  and  was  evidently 
one  of  the  tongue-like  or  ribbon  processes  broken  off  from 
the  mass.  There  could  therefore  be  no  further  doubt  as  to 
the  exact  nature  of  the  case.  The  diagnosis  was  con- 


128  MEDICAL  MICROSCOPY. 

firmed  by  subsequent  examination  of  the  parts  after  the 
patient's  death." 

Dr.  Basham  (On  Dropsy,  3d  Edition,  London,  18C6,  p. 
424)  thinks  that  " frequently-recurring  HsBinaturia,  with- 
out any  sedimentary  deposit  in  the  urine  in  the  interval, 
may  be  recognized  as  pathognomonic  of  malignant  disease 
of  the  kidney." 

In  some  cases  of  tubercle  of  the  kidney  it  is  stated  by 
various  authors  that  portions  of  tuberculous  matter  may  be 
found  as  a  deposit  in  the  urine  ;  and  although  the  recent 
researches  of  Niemeyer  and  others  (see  Chap.  X.)  render 
it  more  than  doubtful  whether  the  doctrine  of.Lebert  in 
regard  to  the  existence  of  a  specific  tubercle  cell  is  correct, 
it  may  not  be  amiss  to  quote  the  following  description  of 
tubercular  elements  (referred  to  on  page  394  of  Beale's 
work  on  Kidney  Diseases)  from  p.  204  of  his  Microscope 
in  Practical  Medicine:  "When  examined  under  the  micro- 
scope, Tubercle  is  seen  to  consist  of  a  great  number  of 
small  particles,  for  the  most  part  of  an  oval  form.  They 
vary  sometimes  in  size  and  form,  are  evidently  solid,  and 
have  a  granular  appearance.  The  great  majority  of  them 
contain  nothing  like  a  nucleus.  They  have  been  described 
as  free  nuclei,  but  I  have  never  been  able  to  satisfy  myself 
that  this  view  of  their  nature  is  correct.  They  become  in- 
distinct when  immersed  in  glycerin,  and  are  rendered 
transparent  by  acetic  acid.  Much  granular  matter  and 
many  minute  oil  globules  are  usually  present.  Tubercle 
corpuscles  are  about  the  -$jfc$  °f  an  mcn  m  their  long 
diameter." 

If  the  urine  under  examination  exhibits  neither  blood 
corpuscles  nor  cancer  cells,  but  is  found  to  contain  minute 
crystals  apparently  square  and  marked  with  a  cross  formed 
of  spindle-shaped  diagonals,  but  in  reality  of  a  flattened 
octahedral  form,  as  shown  in  Fig.  11,  the  deposit  is  OXA- 
LATE  OF  LIME,  and  the  case  is  one  of  OXALURIA.  When 


URINE—  BL 0 OD   COR P USCL I  >.     /  / '<'. 


I'J'J 


FIG.  11. 


these  crystals  are  of  large  size  (TTFVir  °f  an  >nc^  'in  diam- 
eter) they  may  be  recognized  with  the  greatest  ease,  and 
form  some  of  the  most  beautiful  microscopic  objects  to  be 
met  with  in  the  whole  range  of  urinary  deposits,  almost 
tempting  the  microscopist,  for  the  instant,  to  seek  out  one 
of  unusual  size  and  have  it  set  in  a  ring  as  a  jewel ;  but 
should  they  happen  to  be  very  minute,  as  is  often  the  case, 
they  may  readily  be  passed  over  with  a  low  power  as 
granules  of  amorphous  urates  or  spores  of  fungi;  if  closely 
scrutinized,  however,  the  particles  will  be  seen  to  present 
a  rectangular  instead  of  a 
rounded  form,  and  the  question 
may  generally  be  decided  by 
examination  with  a  power  of 
600  diameters,  or  by  permit- 
ting the  urine  to  stand  undis- 
turbed another  twenty-four  or 
thirty-six  hours,  to  allow  of 
further  crystallization.  In  my 
experience,  however,  it  is  un- 
usual for  oxalate  of  lime  to  ex- 
ist in  any  considerable  amount 
without  some  few  crystals  being 

large  enough  for  recognition  with  a  good  £  inch  objective. 
Occasionally  oxalate  of  lime  occurs  in  the  form  of  Dumb- 
bells, or  rather,  as  remarked  by  Dr.  Bird  (to  whose  re- 
searches we  owe  much  of  our  knowledge  in  relation  to  this 
deposit),  like  two  kidneys  with  their  concavities  opposed 
and  sometimes  so  closely  approximating  as  to  appear  cir- 
cular, the  surfaces  being  finely  striated;  still  more  rarely 
the  dumb-bells  present  the  appearance  of  oval  laminae,  with 
or  without  a  species  of  nucleus,  and  the  ordinary  octahedra 
take  the  shape  of  square  prisms  crowned  with  four-sided 
pyramids,  but  these  varieties  of  form  generally  alternate 
with  or  are  soon  permanently  replaced  by  the  ordinary 

12 


OXALATE  OF  LIME  CRYSTALS.  (After 
Bird.)     X  200  Diameters. 


130  MEDICAL  MICROSCOPY. 

octahedral  crystals.  The  lamented  Dr.  Bird  considered  it 
probable  that  the  dumb-bell  crystals  were  composed  of 
oxalurate  of  lime,  which  differed  from  the  common  oxalate 
in  becoming  strongly  illuminated  by  polarized  light;  but, 
as  shown  by  Dr.  Thudichum  and  confirmed  by  Dr.  Beale, 
the  ordinary  octahedra  do  polarize,  and  cannot,  therefore, 
on  that  ground  be  considered  of  different  constitution. 

In  the  course  of  investigations  to  determine  the  cause 
of  the  formation  of  dumb-bells,  Dr.  Beale  arrived  at  the 
conclusion,  that  they  result  from  certain  conditions  uncon- 
nected with  any  particular  morbid  state,  appearing  in  the 
urine  of  persons  who  take  little  exercise  and  indulge  in 
rich  diet  with  too  little  water;  they  have  been  seen  im- 
pacted in  the  uriniferous  tubules,  and  they  as  well  as 
octahedral  crystals  sometimes  occur  imbedded  in,  or  de- 
posited upon,  tube-casts.  The  octahedra,  especially,  have 
a  strong  tendency  to  deposit  themselves  upon  fragments  of 
hair,  linen  fibers,  etc.,  a  curious  instance  of  which  disposi- 
tion, simulating  spermatozoa,  is  described  on  p.  100. 

As  a  sediment  in  the  urine,  oxalate  of  lime  is  often  asso- 
ciated with  uric  acid  and  urates,  triple  phosphate,  epithe- 
lial cells,  and  vesical  mucus.  Minute  crystals  may  be 
distinguished  from  granules  of  the  uric  acid  salts  by  their 
insolubility  on  warming  the  slide,  and  larger  ones  from 
abbreviated  prisms  of  triple  phosphate  by  their  insolubility 
in  acetic  acid. 

The  clinical  importance  of  Oxalate  of  lime  in  the  urine 
has  been  much  debated,  and  still  remains  unsettled,  although 
the  most  recent  authorities  are  disposed  to  attribute  little 
significance  to  the  so-called  oxalic  acid  diathesis.  Accord- 
ing to  Dr.  Bird,  Oxaluria  may  occur  either  with  or  without 
excess  of  urea  and  extractive  matter  in  the  urine.  In  the 
former  condition  patients  are  generally  remarkably  de- 
pressed in  spirits  and  of  a  melancholy  aspect;  they  are 
often  much  emaciated,  excepting  in  slight  cases,  extremely 


URINE— BLOOD   CORPUSCLES,  ETC.  131 

nervous,  and  painfully  susceptible  to  external  impressions, 
often  hypochondriacal  to  an  extreme  degree,  and  in  very 
many  instances  labor  under  the  impression  that  they  are 
about  to  fall  victims  to  consumption.  There  is  generally  in- 
ability for  exertion,  fever,  the  feet  and  hands  being  hot  and 
dry,  irritability  of  temper,  want  of  sexual  power,  and  a 
severe  and  constant  pain  or  sense  of  ^veight  across  the 
loins,  with  some  amount  of  irritability  of  the  bladder.  The 
urine  is  invariably  acid  and  of  high  specific  gravity,  owing 
to  the  excess  of  urea  and  extractive  matter.  The  oxalate 
of  lime  is  attributed  to  an  exaggerated  activity  of  the 
second  stage  of  the  secondary  or  destructive  assimilation, 
the  metamorphosis  of  tissue  of  Liebig.  Oxaluria  without 
excess  of  urea  or  extractive  matter  is  in  general  merely 
one  of  a  series  of  symptoms  developed  under  the  influence 
of  maladies  which  interfere  with  the  assimilative  functions; 
it  occurs  in  many  acute  affections,  such  as  rheumatism,  and 
in  chronic  diseases  attended  with  gastralgia,  especially 
chronic  dyspepsia,  when  the  crystals  sometimes  seem  to 
act  as  a  local  irritant  to  the  neck  of  the  bladder.  This 
condition  is  also  apt  to  exist  associated  with  long-standing 
pulmonary  disease,  such  as  chronic  bronchitis  and  em- 
physema. 

On  the  other  hand,  Dr.  Roberts  maintains  that  "  Intense 
oxaluria  may  continue  persistently  without  evoking  the 
group  of  symptoms  attributed  to  the  oxalic  diathesis,"  and 
in  this  statement  he  is  supported  by  the  more  recently 
published  observations  of  Dr.  Beale,  who  also  declares, 
"  This  group  of  symptoms  may  exist  in  typical  develop- 
ment without  the  occurrence  of  deposits  of  oxalate  of  lime 
in  the  urine ;"  and  further,  "  The  most  varied  morbid  states 
coexist  with  oxaluria."  According  to  F.  W.  Bencke,  oxa- 
luria is  chiefly  produced  by  any  cause  which  retards  the 
metamorphosis  of  the  nitrogenous  constituents  of  the 
blood,  such  as  abuse  of  azotized  articles  of  food,  or  of 


132  MEDICAL   MICROSCOPY. 

saccharine  and  starchy  substances,  insufficiency  of  the  red 
blood  corpuscles,  insufficient  enjoyment  of  pure,  fresh  air, 
organic  lesions  which  impede  respiration  and  circulation, 
and  depressed  conditions  of  the  nervous  system,  whether 
mental  or  otherwise. 

Dr.  Roberts  admits,  however,  that  "  apart  from  the  ex- 
istence of  organi%disease,  the  conditions  most  frequently 
found  associated  with  oxaluria,  varied  as  they  are,  call  for 
a  tolerably  uniform  therapeutical  action,"  so  that,  practi- 
cally, the  difference  in  his  views,  acknowledging  them  to 
be  correct,  requires  little  or  no  corresponding  variation  in 
treatment.  In  the  first  place,  digestion  should  bje  promoted 
by  the  administration  of  the  mineral  acids  in  light,  bitter 
infusions,  especially  when  the  dyspeptic  symptoms  point 
to  an  atonic  state  of  the  organ  and  of  the  body  generally  ; 
or  should  the  signs  indicate  gastric  or  general  irritation, 
small  doses  of  bicarbonate  of  potash  in  a  bitter  combina- 
tion may  prove  more  efficient.  The  patient  should  eat 
moderately  of  well-cooked  digestible  food,  obtained  in 
about  equal  proportions  from  the  vegetable  and  animal 
kingdoms,  carefully  avoiding  any  articles  which  tend  to 
produce  flatulence.  Milk  should,  for  a  time  at  least,  be 
substituted  for  tea  and  coffee,  and  should  it  prove  nausea- 
ting may  be  mixed  with  one-fourth  its  bulk  of  lime- 
water. 

If  the  sediment  is  composed  of  minute  crystals,  just 
visible  to  the  naked  eye  as  reddish-brown  or  orange-red 
glittering  points  adhering  to  the  sides  of  the  vessel  and  to 
any  little  hairs  or  fibers  occurring  in  the  urine,  it  may  be 
presumed  to  be  URIC  or  LITHIC  ACID  ;  but  a  specimen 
should  be  examined  as  directed  on  p.  60,  with  a  power  of 
100  or  200  diameters,  when  the  rhombic  prisms  or  lozenges 
a,  b,  c,  e  of  this  deposit,  often  with  their  angles  rounded 
off  into  ovoids  and  barrel  shapes,  d,  will  probably  be  dis- 
covered. Uric  acid  assumes  an  immense  variety  of  forms, 


URINE— BLOOD    CORPUSCLES,  ETC. 


133 


most  of  which  may  be  traced  to  modifications  of  the 
rhombic  system,  produced,  it  would  appear  from  the  ex- 
periments of  Dr.  Ernest  Sansom,  by  differences  in  the 
strength  of  the  solution  from  which  crystallization  takes 
place,  very  elongated  lozenges  or  tables,  and  even  acicu- 
lar  prisms,  being  formed  if  the  mother-liquid  contains  a 
large  amount  of  acid.  The  well-marked  yellow  color  of 

FIG.  12. 


URIC  ACID  CRYSTALS.    (After  Roberts.)    X  200  Diameters. 

its  crystals  under  the  microscope,  as  contrasted  with  the 
pure,  colorless  aspect  of  the  phosphates  and  the  extremely 
faint  greenish  tint  of  the  oxalates,  is  often  a  valuable 
assistance  in  diagnosis  when  the  lozenges,  etc.  are  im- 
perfect. According  to  Dr.  Beale,  this  deposit  sometimes 
occurs  in  the  form  of  thin  glistening  films,  and  as  an 
amorphous  powder  resembling  urates,  but  in  either  case, 
after  standing  forty-eight  hours,  crystalline  forms  appear. 
The  chemical  characters  of  uric  acid,  which  enable  us 

12* 


134  MEDICAL   MICROSCOPY. 

to  recognize  it  in  cases  when  the  microscope  fails  at  first, 
are,  its  solubility  in  caustic  potash  and  soda,  from  which 
it  may  be  precipitated  in  lozenges  by  acetic  acid,  and  the 
production  of  a  violet  color  (that  of  murexide)  when  the 
suspected  sediment  is  treated  with  strong  nitric  acid,  evap- 
orated to  dryness  at  a  gentle  heat,  and  a  drop  of  ammonia 
added  to  the  residue. 

The  amount  of  uric  acid  occurring  normally  in  healthy 
urine  is  very  small,  and  does  not  usually  exceed  more 
than  ten  grains  per  diem,  although  Surgeon-General  Ham- 
mond (who  is,  however,  of  unusual  size)  found  his  daily 
average  as  high  as  14-14  grains;  yet  Ranke  asserts  that 
neither  sex,  age,  nor  height  and  weight  of  body  have  any 
marked  relation  to  the  diurnal  excretion  of  uric  acid.  It 
is  found,  on  testing,  to  decrease  in  an  attack  of  gout,  and 
to  decidedly  increase  after  the  arthritic  paroxysm  ;  during 
certain  diseases  and  even  temporary  congestions  of  the 
liver,  and  in  febrile  states  of  the  system  generally. 

The  clinical  importance  of  a  sediment  of  uric  acid  oc- 
curring after  twelve  hours'  standing  is  very  slight,  since  it 
is  apt  to  take  place  in  perfectly  normal  urine,  as  a  result  of 
acid  fermentation ;  but  should  a  deposit  of  this  substance 
be  let  fall  as  the  urine  cools,  or  shortly  afterward  (Lithu- 
ria\  serious  apprehension  must  be  felt  lest  crystallization 
may  occur  in  the  urinary  passages  and  give  rise  to  all  the 
painful  and  dangerous  symptoms  produced  by  nephritic 
and  vesical  calculi.  Dr.  Bird  states  that  a  so-called  pisi- 
form deposit  of  uric  acid  is  very  common  in  gouty  persons, 
and  occurs  in  little  spherical  masses,  of  a  pale-yellow  color, 
varying  in  size  from  that  of  small  millet-seeds  to  that  of  a 
pea,  rather,  indeed,  to  be  referred  to  the  class  of  calculi 
than  of  sediments ;  such  aggregations  of  crystals  often 
produce  the  agonizing  suffering  of  nephritic  colic  during 
their  passage  along  the  ureter.  According  to  the  same 
author,  the  conditions  under  which  an  excess  of  uric  acid, 


URINE— BLOOD   CORPUSCLES,  ETC.  135 

cither  alone  or  in  combination  with  alkalies,  occurs  in  the 
urine,  a  normal  quantity  of  water  being  present,  are — First, 
a  waste  of  tissue  more  rapid  than  the  supply  of  nitrogen- 
ized  nourishment,  as  in  fever,  acute  inflammation,  and 
phthisis.  Second,  supply  of  nitrogen  in  the  food  greater 
than  is  required  for  the  reparation  and  supply  of  tissue,  as 
in  excessive  consumption  of  animal  food,  or,  the  quantity 
of  food  remaining  the  same,  indulgence  in  insufficient 
bodily  exercise.  Third,  supply  of  nitrogenized  food  not 
being  in  excess,  but  the  digestive  functions  unable  to  as- 
similate it,  as  in  all  the  varieties  of  dyspepsia.  Fourth, 
the  cutaneous  outlet  for  nitrogenized  excreta  being  ob- 
structed, the  kidneys  are  called  upon  to  compensate  for 
the  deficient  function,  as  in  all  or  most  stages  of  diseases 
attended  with  arrest  of  perspiration.  Fifth,  congestion 
of  the  kidneys  produced  by  local  causes,  as  blows  and 
strains  of  the  loins,  or  disease  of  the  genital  apparatus. 
Dr.  Beale  observes,  "  In  chronic  diseases  of  the  respira- 
tory organs  we  often  meet  with  uric  acid  and  urates  in 
the  urine.  It  is  common  in  emphysema  of  the  lungs,  and 
in  chronic  bronchitis.  In  pneumonia  and  rheumatic  fever 
it  is  often  found.  It  is  seldom  absent  from  the  urine  in 
chorea,  and  very  often  exists  in  various  forms  of  skin  dis- 
ease, and  in  cases  of  acute  inflammation  of  the  kidney.  It 
is  occasionally  met  with  in  diabetes.  There  are  many 
cases  in  which  the  tendency  to  deposits  of  uric  acid  is  not 
very  easily  explained.  Some  children  are  very  liable  to 
suffer  from  these  deposits,  and  their  appearance  is  accom- 
panied by  frequent  desire  to  pass  urine.  In  cases  where 
this  state  of  urine  is  very  frequent,  it  is  necessary  for  the 
practitioner  to  interfere."  When  deposits  of  uric  acid 
occur,  and  especially  if  the  patient  is  of  a  gouty  tendency, 
he  highly  recommends  small  doses  of  chlorohydric  acid, 
with  pepsin,  before  meals,  and  twenty  grains  of  bicar- 
bonate of  potash  in  half  a  tumbler  of  water  after  meals, 


136  MEDICAL  MICROSCOPY. 

but  mentions  that  in  some  cases  the  ordinary  remedies 
appear  to  have  no  effect.     Dr.  Bird  classifies  the  indica- 
tions for  treatment  as  follows:  first,  attention  to  the  func- 
tion of  the  skin ;  second,  restoration  of  tone  to  the  organs 
of  digestion ;  and  third,  administration  of  remedies  which 
act  as  solvents  of  uric  acid.     In  regard  to  the  first,  he  re- 
marks, "  I  have  repeatedly  seen  diaphoretics,  warm  cloth- 
ing, the  use  of  flannel,  and  in  winter  even  a  chamois  leather 
waistcoat,  with  friction  by  means  of  a  flesh-glove  or  hair- 
glove,  repeatedly  (in  the    a  me  case?)  remove  a  deposit  of 
uric  acid  gravel ;  and,  in  more  than  one  instance,  where 
even  an  hereditary  taint  existed  from  gouty  or  calculous 
progenitors."     And  he  attributes  the  extreme  rarity  of 
calculous  disorders  among  seamen  in  the  navy  to  the  kind 
of  vapor-bath  in  which  they  sleep  when  crowded  between- 
decks.     To  fulfill  the  second  indication,  he  advises  careful 
regulation  of  the  bowels,  by  mercurial  and  other  purga- 
tives, and  moderate  doses  of  carbonate  of  potassa  or  soda, 
in  infusions  of  gentian,  columbo,  or  serpentaria,  and  the 
relief  of  gastrodynia  (with  or  without  pyrosis),  by  the 
administration  of  half  a  grain  of  nitrate,  or  one,  of  the  oxide 
of  silver,  immediately  before  a  meal ;  abstinence  from  large 
quantities  of  food,  and,  in  protracted  cases,  from  all  nitro- 
genous diet,  being  enjoined ;  finally,  as  a  solvent  of  uric 
acid,  he  recommends  the  bicarbonate  of  potassa,  in  half- 
drachm  doses,  three  times  daily,  stirred  up  with  five  grains 
of  citric  acid  in  a  tumbler  of  warm  water,  or  the  acetate, 
citrate,  or  -tartrate  of  potash  may  be  given  in  solution, 
freely  diluted,  or  the  celebrated  Yichy  water  can  be  tried. 
In  conducting  the  solvent  treatment  of  uric  acid  calculi, 
Dr.  Roberts  directs  that  the  urine  should  be  rendered  de- 
cidedly alkaline,  by  doses  of  forty  to  sixty  grains  of  acetate 
or  citrate  of  potash,  dissolved  in  four  ounces  of  water,  and 
regularly  repeated  every  three  hours,  except  during  sleep, 
to  avoid  any  return  of  acidity  in  the  renal  secretion.     He 


URINE— BLOOD   CORPUSCLES,  ETC.  1JJ7 

states  that  he  has  employed  the  bicarbonate,  acetate,  and 
citrate  of  potash,  in  doses  of  from  four  to  eight  drachms  in 
t  unity-four  hours,  in  a  very  large  number  of  cases,  for 
periods  varying  from  a  fortnight  to  three  months,  and  in 
no  instance  were  deleterious  effects  observed ;  but  he  con- 
siders the  solvent  treatment  "  only  applicable  in  those 
cases  of  vesical  calculi  in  which  the  urine  is  acid,  the  stone 
not  large,  (and)  its  composition  known  to  be  uric  acid,  or 
strongly  suspected  to  be  such." 

CARBONATE  OF  LIME  is  one  of  the  rare  sediments  from 
human  urine,  although  said  to  be  quite  common  in  that 
of  the  horse,  occurring,  in  both  cases,  in  the  form  of 
spherules  composed  of  aggregated  acicular  crystals.  It 
may  be  recognized,  either  when  actually  deposited,  or  in- 
troduced in  the  form  of  chalk  or  marble  dust  for  purposes 
of  deception,  by  dissolving  with  the  evolution  of  carbonic 
acid  gas  in  acetic  acid. 

If  the  deposit  is  whitish,  and  under  the  microscope 
(examined  as  directed  on  page  69)  is  found  to  consist  of 
six-sided  plates,  which,  when  dissolved  in  liquor  ammoniae, 
are  re-deposited  in  the  same  form  on  its  evaporation,  it  is 
composed  of  CYSTINE.  This  substance,  remarkable  for 
containing  nearly  twenty-six  per  cent,  of  sulphur,  is  solu- 
ble in  caustic  potash  and  its  carbonate,  and  in  the  mineral 
acids,  but  insoluble  in  carbonate  of  ammonia,  acetic  and 
tartaric  acids,  water,  and  alcohol.  When  heated  on  platina 
foil  in  the  flame  of  a  spirit-lamp  it  evolves  thick  white 
fumes  of  a  disagreeable  odor  resembling  garlic.  Accord- 
ing to  Dr.  Bird,  the  urine  depositing  cystine  is  generally 
pale  yellow,  of  a  somewhat  oily  appearance,  having  fre- 
quently the  odor  of  sweet-brier  and  being  of  less  than  the 
normal  specific  gravity.  Sometimes  its  smell  more  nearly 
resembles  that  of  putrid  cabbage,  probably  owing  to  de- 
composition and  the  evolution  of  sulphuretted  hydrogen, 
and  in  such  specimens  the  color  changes  from  pale  yellow 


138  MEDICAL  MICROSCOPY. 

to  green.  The  crystals  of  cystine  fire  often  aggregated  to- 
gether in  the  form  of  rosettes,  and  even  single  crystals  are 
sometimes  marked  with  confused  lines  near  their  centers 
of  troubled  crystallization ;  occasionally  square  prisms  are 
found  associated  with  the  usual  hexagonal  laminae.  Com- 
mon salt  (chloride  of  sodium)  is  the  only  body  likely  to 
occur  in  urine  and  be  mistaken  for  .cystine  ;  it  may  at  once 
be  distinguished  by  being  readily  soluble,  when  a  large 
quantity  of  water  is  added. 

The  origin  of  cystine  in  the  human  body  has  not  yet 
been  discovered  ;  but  Dr.  Roberts  observes  that  "the  close 
analogy  of  composition  between  it  and  taurine  renders  it 
not  improbable  that  the  liver  is  the  original  source  of  cys- 
tine, and  the  discovery  of  cystine  in  the  livers  of  typhus 
patients  by  Scherer  lends  support  to  this  view."  It  is 
remarkable  that  the  tendency  to  formation  of  this  deposit 
should  be  strongly  hereditary,  Dr.  Bird  referring  to  an  in- 
stance when  it  appeared  in  three  successive  generations. 
The  production  of  cystine  seems  to  be  connected  with  de- 
pression of  the  vital  powers,  especially  in  strumous  con- 
stitutions; but,  beyond  the  local  and  mechanical  irritation 
caused  by  the  crystals,  the  chief  danger  is  apparently 
their  aggregation  into  a  calculus.  In  the  treatment  of 
Gystinuria  Dr.  Front  recommends  the  persistent  use  of 
mtro-hydrochloric  acid,  but  Dr.  Bird  and  Dr.  Beale  have 
not  found  this  method  satisfactory,  and  place  much  more 
reliance  upon  the  administration  of  iron,  particularly  the 
syrup  of  the  iodide,  conjoined  with  sea-bathing,  exercise, 
attention  to  diet  and  to  the  functions  of  the  skin. 

XANTHINE,  XANTHIC  OXIDE,  or  URIC  OXIDE  is  a  very 
rare  deposit,  in  appearance  strongly  resembling  uric  acid, 
from  which  it  may,  however,  be  distinguished  by  its  ready 
solubility  in  hot  water  and  in  the  mineral  acids.  As  but 
four  or  five  cases  in  all  are  reported,  its  clinical  importance 
is  very  small. 


—  BLOOD   CORPUSCLES.  ETC.  ]39 

SILICA,  in  the  form  of  common  sand,  has  sometimes 
been  added  to  the  urine  by  hysterical  females  to  deceive 
the  physician ;  it  may  be  detected  by  its  insolubility  in 
boiling  nitric  acid. 

TYROSINE,  which  occurs  in  some  cases  of  disease,  and 
especially  of  acute  atrophy  of  the  liver,  as  a  deposit  in  the 
urine  of  acicular  crystals  aggregated  in  sheaf-like  bundles 
or  globular  masses,  is  considered  by  Frerichs  as.  an  im- 
portant aid  to  diagnosis.  In  cases  of  suspected  acute 
yellow  atrophy  of  the  liver  a  few  drops  of  the  urine 
should  be  evaporated  in  a  watch-glass  nearly  to  dryness, 
and  the  residue  examined  microscopically  for  tyrosine ; 
LEUCINE  will  probably  also  be  present,  generally  in  the 
form  of  oily-looking  globules,  but  when  pure  it  crystallizes 
in  delicate  needles.  (See  case  of  Leucinosis,  by  Prof.  II.  C. 
Wood,  Jr.,  reported  in  Trans.  Coll.  of  Physicians  of  Phila., 
Am.  Jour,  of  Ned.  Sci.,  April,  18G7.) 

The  presence  of  ENTOZOA  in  the  urine  when  passed  ap- 
pears to  be  comparatively  rare  in  this  country,  although 
numerous  cases  are  recorded  abroad.  Among  the  species 
described  by  Dr.  Beale  may  be  mentioned  small  hydatids 
which  have  escaped  from  parent  cysts  in  the  kidneys,  also 
echinococci  and  their  booklets  (the  latter  very  character- 
istic) which  have  been  detected  in  some  cases ;  the  Diplo- 
soma  crenata,  a  worm  from  four  to  six  inches  long,  of 
which  a  single  case  is  reported  by  Dr.  Arthur  Farre ;  the 
Strongylus  gigas,  which  reaches  a  length  of  fifteen  inches 
and  may  exist  coiled  up  in  the  kidney ;  the  Distoma  haBma- 
tobium,  said  to  be  very  abundant  in  Egypt;  and  the  Bil- 
harzia  haematobia  and  capensis,  the  latter  species,  as 
shown  by  Dr.  John  Harley,  being  the  cause  of  a  form  of 
haamaturia  endemic  in  some  parts  of  the  Cape  of  Good 
Hope.  (See  Chap.  IX.) 


CHAPTER   VI  I. 

EXAMINATION   OF    URINE. 

Substances  which  Float  in  or  upon  the  Fluid  (including  Extra- 
neous Matters).— Recapitulation  and  Remarks. 

URINE  which  has  been  allowed  to  stand  for  about  twelve 
hours,  as  directed  in  Chapter  III.  (p.  68),  is  occasionally 
found,  on  examination,  free  from  deposit,  and  yet  pre- 
senting a  turbid  aspect,  as  if  some  insoluble  material  had 
been  separated  but  failed  to  subside  to  the  bottom  of  the 
vessel.  This  appearance  may  be  caused — first,  by  the 
presence  of  alkaline  urates  in  a  state  of  extremely  minute 
division,  which  can  be  detected  by  simply  warming  the 
liquid  in  a  test-tube,  and  so  redissolving  the  solid  matter ; 
secondly,  it  may  arise  from  the  rapid  development  of 
Yibriones  and  Bacteria,  which  sometimes  become  so 
numerous  in  a  few  hours  as  to  render  the  urine  quite 
opalescent ;  they  can  be  recognized  without  difficulty  in 
most  cases  by  microscopic  examination  as  directed  on  page 
103,  where  their  pathological  signification  is  considered; 
thirdly,  it  may  have  its  origin  in  the  admixture  of  very 
minute  Fatty  particles  (that  is,  fatty  matter  in  the  so-called 
molecular  state),  constituting  what  is  termed  Chylous 
urine.  Urine  of  this  character  is  often  of  a  pinkish  color, 
from  the  admixture  of  red  blood  corpuscles,  which  may 
be  seen  on  microscopic  examination,  and  Leucocytes  in 
greater  or  less  abundance  are  always  found.  Doubts  as 
to  the  nature  of  the  molecules  may  be  solved  by  agitating 
the  suspected  turbid  urine,  with  about  one-third  its  bulk 
(140) 


URINE— SUBSTANCES  IN  OR    UPON. 


141 


FIG.  13. 


of  sulphuric  ether,  in  a  test-tube,  when  the  fatty  matter,  if 
such  it  is,  will  undergo  solution.  According  to  Dr. 
Roberts,  there  is  a  strong  probability  that  chylous  and 
lymphous  urine  are  respectively  mixtures  of  chyle  and 
lymph  with  the  renal  secretion.  As  this  interesting  and 
remarkable  affection  is  extremely  rare  in  our  climate,  only 
three  cases  being  reported  by  Bird,  Beale,  and  Roberts 
as  occurring  in  persons  who  had  not  resided  in  hot 
countries,  it  seems  unnecessary  to  enter  more  fully  into 
its  details. 

The  pathological  ingredients 
of  the  urine  which  occasionally 
form  a  pellicle  so  thin  that  it 
floats  upon  the  surface  of  the 
fluid,  are  chiefly  amorphous 
Triple  phosphate,  combined  with 
organic  matter,  and  generally 
containing  crystals  of  the  triple 
-phosphate,  sdmetimes  very  mi- 
nute, but  exhibiting  their  char- 
acteristic form  if  sufficiently 

magnified.         When      SUCh     films 

are  formed  by  rapid  evaporation 
of  the  urine,  they  generally  en- 
tangle  urate  of  soda,  crystallized 

in  small  spherical  masses,  from  the  sides  of  which  little 
spicules  project  (Fig.  13).  The  so-called  Kiestine,  investi- 
gated by  Dr.  Kane,  the  celebrated  Arctic  explorer,  when  a 
student  of  medicine,  and  claimed  by  some  to  be  a  pathog- 
nomonic  sign  of  pregnancy,  is  chiefly  composed  of  minute 
oil-globules  which  float  upon  the  surface  of  the  urine, 
associated  with  crystals  of  triple  phosphate. 

UROSTEALITH  is  a  peculiar  form  of  fatty  matter,  occur 
ring  as  small  concretions  in  a  single  case,  that  of  an 
Austrian  weaver. 

13 


UHATE    OF    SODA   AND   FILMS    OF 


x  215  Diameters.  (After  Beaie.) 


142  MEDICAL  MICROSCOPY. 

It  is  obvious  that,  in  spite  of  all  the  precautions  we 
may  adopt  for  obtaining  specimens  of  urine  without  ad- 
mixture with  foreign  bodies,  extraneous  matters  in  im- 
mense variety  will  frequently  present  themselves  beneath 
the  microscope,  and  give  rise  to  much  uncertainty,  or  even 
sometimes  to  erroneous  conclusions,  on  the  part  of  the 
student.  Many  of  these  foreign  bodies  have  been  already 
referred  to,  but  the  importance  of  their  recognition  is  so 
great  that  it  seems  to  warrant  their  detailed  description. 
Among  the  most  common  accidental  impurities  of  urine 
are  the  various  kinds  of  hair  and  wool,  including  human 
hair  (Fig.  14,  c),  cat's  hair,  dog's  hair,  wool  from  a  blanket, 
from  cloth,  and  from  flannel,  it  being  remembered  that 
all  these  different  varieties,  as  well  as  many  other  foreign 
matters,  are  constantly  floating  in  the  air  of  almost  every 
room  of  every  house,  and  require  no  special  and  obvi- 
ous exposure  to  admit  of  their  entrance  into  the  renal 
secretion. 

Many  varieties  of  hair  and  wool  (c)  are  liable  to  be 
mistaken  for  casts  of  the  uriniferous  tubules,  but  may  be  dis- 
tinguished as  follows  :  in  the  first  place,  fragments  of  each 
are  generally  much  longer,  and  larger  in  diameter,  than 
tube-casts ;  their  extremities  are  often  fibrillated,  and  as 
it  were  splintered,  like  the  broken  end  of  a  green  twig, 
instead  of  being  frequently  club-shaped ;  also  their  color 
is  much  darker  than  that  of  the  hyaline  casts,  and  although 
it  may  approach  quite  closely  to  that  of  darkly  granular 
casts,  they  are  obviously  much  more  homogeneous  in  con- 
stitution than  the  latter.  In  doubtful  cases,  I  should  ad- 
vise the  student  to  press  firmly  upon  the  thin  glass  cover 
with  a  mounted  needle  over  the  suspected  body,  as  seen 
with  a  half-inch  objective,  when,  if  it  happens  to  be  a  tube- 
cast,  it  will  be  observed  to  crush  beneath  the  force  applied, 
whilst  the  covering  glass  would  probably  break  before  a 
hair  could  be  more  than  slightly  flattened.  Fragments  of 


URINE— SUBSTANCES  IN  OR    UPON. 


143 


colored  worsted  often  find  their  way  into  urine,  as  well  as 
into  other  fluids  from  the  body,  but  are  generally  easy  to 
recognize,  occasionally  affording  a  hint  to  some  useful  fact. 

FIG.  14. 


EXTRANEOUS  MATTERS  FOUND  IN  URINE.  (After  Roberts.)  X  (probably)  about  200 
Diameters,  a.  Cotton  fibers.  6.  Flax  fibers,  c.  Hairs,  d.  Air-bubbles,  e.  Oil-globules. 
f.  Wheat  starch,  g.  Potato  starch.  /*.  Rice  starch  granules,  t,  i,t.  Vegetable  tis- 
sue, k.  Muscular  fibers  altered  by  soaking  in  fluid.  Some  fragments  of  a  feather 
are  figured  on  tho  extreme  right. 


144  MEDICAL  MICROSCOPY. 

Thus,  for  example,  on  one  occasion,  in  examining  a  drop  of 
blood  from  the  arm  of  a  patient,  I  met  with  a  little  piece 
of  blue  wool ;  glancing  at  the  young  man,  and  observing 
that  he  wore  a  white  shirt  only,  I  said  to  him,  "  Don't 
you  know  you  are  very  likely  to  take  cold  by  going  with- 
out your  blue  flannel  shirt?  When  did  you  leave  it  off?" 
"  Only  this  morning,  doctor,"  replied  he,  with  a  half- 
frightened  air,  which  was  exchanged  for  a  completely 
astonished  one  when  I  explained  how  I  had  detected  his 
imprudence. 

Flax  and  cotton  fibers  (6  and  a)  are  among  the  most 
common  impurities  of  urine,  not  only  being  deposited  as 
dust  from  the  air  of  chambers  where  linen  and  muslin 
sheets  are  so  often  shaken,  but  also  frequently  adhering  to 
the  slides  and  covers  from  the  cloths  used  in  cleansing 
them.  They  may  generally  be  distinguished  from  tube- 
casts,  which  they  chiefly  resemble,  by  their  larger  diameter, 
fibrillated  extremities,  and  somewhat  striated  appearance 
(see  also  Fig.  5,  a) ;  but  the  best  way  for  the  student  to 
become  familiar  with  their  characteristics  is  for  him  to 
scrape  off  a  little  lint,  first  from  a  linen  and  then  from  a 
cotton  handkerchief,  upon  a  slide,  adding  a  drop  of  water 
or  urine,  covering  it  with  thin  glass,  and  examining  it 
with  a  power  of  about  200  diameters.  In  doubtful  cases 
the  "  pressure  test"  recommended  above  may  often  be 
used  with  advantage. 

Fibers  of  silk,  especially  if  uncolored,  more  nearly  ap- 
proach tube-casts  in  size  than  any  of  the  preceding,  and 
indeed  are  not  unlike  some  specimens  of  hyaline  casts ; 
they  should  be  carefully  studied  by  the  youthful  microsco- 
pist,  who  will  here  find  the  pressure  test  particularly  ap- 
plicable Dr.  Beale  states  that  "their  smooth,  glistening 
appearance  and  small  diameter  at  once  distinguish  them 
from  small  portions  of  urinary  casts,  and  their  clear  out- 
line and  regular  size  from  shreds  of  mucus,  etc." 


URINE— SUBSTANCES  IN  OR    UPON.  145 

Portions  of  feathers  (see  Fig.  14)  from  beds  and  pil- 
lows are  occasionally  met  with  in  urine,  but,  as  they  bear 
no  close  resemblance  to  any  of  its  normal  or  pathological 
ingredients,  are  not  dangerous  impurities,  although  often 
very  puzzling  to  the  beginner;  it  is  stated  that  they 
have  been  mistaken  for  nerve-tubes;  but  a  few  minutes' 
study  would  probably  fix  their  characters  in  the  mind's 
eye  so  firmly  as  to  render  such  an  error  subsequently 
impossible. 

Fibers  of  coniferous  wood  are  said  to  occur  very  fre- 
quently in  the  urine  in  houses  where  the  floors  are  bare 
and  unpainted,  but  are  not  often  found,  so  far  as  my  expe- 
rience goes,  in  our  large  cities ;  they  may  be  readily  studied 
by  cutting  with  a  sharp  knife  a  very  thin  longitudinal  shav- 
ing from  a  piece  of  soft  pine  wood,  such  as  a  match,  and 
examining  it  in  fluid.  Dr.  Beale  remarks  :  "  Of  all  the  ex- 
traneous matters  likely  to  be  met  with  in  urine  most  cal- 
culated to  deceive  the  eye  of  the  observer,  none  are  more 
puzzling  than  the  short  pieces  of  single  fibers  of  deal.  In 
hospitals,  where  the  floor  is  uncovered  and  frequently 
swept,  portions  of  the  fibers  of  the  wood  are  detached, 
and,  being  light,  very  readily  find  their  way  into  any  ves. 
sel  which  may  be  near.  In  fact,  these  fibers  enter  largely 
into  the  composition  of  the  dust  which  is  swept  up.  I 
was  familiar  with  the  appearance  of  these  bodies  for  a 
long  time  before  I  ascertained  their  nature  ;  for,  although 
the  peculiar  characters  of  coniferous  wood  are  sufficiently 
well  marked,  when  only  very  small  portions  are  present, 
and  in  a  situation  where  they  would  scarcely  be  expected 
to  be  met  with,  their  nature  may  not  be  so  easily  made  out. 
Often  only  two  or  three  pores  may  be  seen,  and  not  un- 
frequently  these  are  less  regular  than  usual,  in  which  case 
they  may  be  easily  mistaken  for  a  small  portion  of  a  cast 
with  two  or  three  cells  of  epithelium  contained  within  it. 
I  have  very  frequently  met  with  these  fibers  amongst  the 

13* 


146  MEDICAL   MICROSCOPY. 

deposit  of  various  specimens  of  urine  which  have  been 
obtained  from  private  as  well  as  from  hospital  patients." 

Starch  granules  (/,  g,  and  h),  either  deposited  from  the 
air  as  dust,  or  accidentally  and  even  purposely  introduced, 
as  particles  of  boiled  potato,  boiled  rice,  crumbs  of  bread, 
etc.,  are  often  to  be  met  with  in  urine,  and  mislead  the  un- 
practiced  observer.  They  may  generally  be  detected  by 
the  action  of  solution  of  iodine,  which  produces  a  deep 
blue  or  purple  color,  except  where  the  granules  have  un- 
dergone complete  conversion  into  dextrine,  which  gives  a 
brown  tint  with  the  reagent:  but,  to  avoid  mortifying 
blunders,  specimens  of  starches  should  be  carefully  studied, 
both  dry  and  immersed  in  various  fluids. 

Portions  of  tea-leaves  sometimes  find  their  way  into  the 
urine  and  give  rise  to  much  speculation  among  the  inex- 
perienced ;  they  may  generally  be  distinguished,  after  a 
little  preliminary  study  of  the  deposit  from  a  tea-pot,  by 
their  regular  cellular  structure  and  minute  spiral  vessels. 

Milk  (Fig.  16)  is  sometimes  added  to  urine  for  the 
purpose  of  deception,  but,  according  to  Dr.  Beale,  may  be 
almost  always  diagnosticated,  by  its  globules,  from  the 
fatty  matter  of  chylous  urine,  which  is  generally,  if  not 
universally,  in  a  molecular  state.  Globules  of  sweet  oil 
(e)  sometimes  occur  in  the  urine  of  patients  suffering  with 
stricture,  being  derived  from  the  catheters  and  other  in- 
struments employed. 

As  already  mentioned,  scratches,  indentations,  and  mi- 
nute excavations  in  the  surface  of  the  glass  slide  or  cover, 
both  clean  and  when  filled  with  coloring-matter,  are  very 
liable  to  puzzle  a  juvenile  microscopist ;  and  indeed  I 
have  reason  to  suppose  that  these  microscopic  dirt-pits 
have  temporarily  misled  very  skillful  observers.  Their 
delusive  character  may  be  readily  studied  by  rubbing 
bright  and  clean  an  ordinary  glass  slide  that  has  for 
some  time  been  in  daily  use  for  examinations  of  blood  and 


URINE— SUBSTANCES  IN  OR    UPON.  147 

urine,  and  inspecting  its  surface  with  a  power  of  about 
200  diameters. 

Expectorated  matters  (see  Fig.  20),  including  all  those 
substances  enumerated  in  Chapter  VIII.  as  possible  in- 
gredients of  the  saliva,  and  Vomited  materials,  among 
which  may,  of  course,  occur  each  of  the  different  articles 
of  food,  frequently  become  mixed  with  urine,  and  are 
liable  to  give  rise  to  error.  In  cases  of  doubt  or  sus- 
pected imposition,  the  precaution  should  be  taken  of 
having  the  urine  passed  into  a  clean  vessel,  in  the  presence 
of  the  physician  or  nurse,  and  immediately  transferred  to 
a  freshly-washed  vial  and  securely  corked.  A  case  re- 
cently came  before  the  Biological  and  Microscopical  Depart- 
ment of  the  Academy  of  Natural  Sciences  in  this  city,  when 
some  minute  worms,  supposed  to  be  trichinae,  were  found  in 
the  urine  ;  but,  on  being  referred  to  Prof.  Joseph  Leidy,  he 
decided  that  they  were  specimens  of  the  Anguillula  aceti,  or 
vinegar  eel  (see  Chapter  XIII.),  probably  introduced  by 
the  patient  with  the  design  of  puzzling  the  doctors. 

The  questions  to  be  solved  by  examination  of  the  urine 
form  so  large  a  part  of  the  problems  submitted  to  the  micro- 
scopist,  that,  although  the  investigation  of  deposits  from 
the  renal  secretion  has  been  so  fully  discussed  in  the 
preceding  chapters,  I  am  confident  that  a  brief  review  of 
the  subject  will  prove  useful  to  some  who  may  consult 
these  pages,  more  especially  if,  as  sometimes  unavoidably 
happens,  their  researches  must  be  hurriedly  made,  owing 
to  the  pressure  of  other  engagements. 

In  the  examination  of  urine,  then,  we  may  find  that — 

1st.  It  lets  fall  a  distinct  deposit. 

A.  This  deposit  is  Light  and  Flocculent. 

a.  It  occurs  in  Albuminous  urine,  that  is,  one 
yielding  a  coagulum  on  testing  with  heat  and 
nitric  acid  (see  p.  68). 

a.  On   microscopic    examination    (p.    69) 


148  MEDICAL  MICROSCOPY. 

CASTS  Of  the  uriniferous  tubules  (trans- 
parent or  granular  cylinders,  -3-^  to  lirVir 
of  an  inch  in  diameter),  Granular,  Epithe- 
lial, or  Hyaline  (p.  10),  are  found.  The 
patient  is  suffering  from  Bright1  s  dis- 
ease of  the  Kidney,  whose  form  and 
stage  are  to  be  diagnosticated  as  directed 
on  page  82  et  sequitur. 
fi.  Under  the  microscope,  RED  BLOOD 
CORPUSCLES  (non-nucleated  globules  -5-^-5- 
of  an  inch  in  diameter,  p.  121),  mixed  with 
more  or  less  mucus,  can  alone  be  dis- 
tinguished. The  affection  is  Hsematuria. 
(See  Chapter  VL,  p.  125.) 
f.  LEUCOCYTES  (nucleated  corpuscles  aver- 
aging -^(j  of  an  inch  in  diameter,  p.  114) 
(in  this  albuminous  liquid,  pus  corpuscles) 
are  present  without  any  other  ingredients. 
These  indicate  inflammation  of  some 
portion  of  the  urinary  tract  (Nephritis, 
Cystitis,  etc.j  for  whose  diagnosis  see 
Chapter  Y.,  p.  111). 

6.  The  deposit  takes  place  in  urine  which  is 
not  albuminous,  yielding  no  coagulum  on 
testing  with  heat  and  nitric  acid. 

a.  On  microscopic  examination  LEU- 
COCYTES (nucleated  cells  averaging  2^o 
of  an  inch  in  diameter),  epithelial  cells 
from  the  bladder,  and  perhaps  long, 
twisted,  transparent  mucous  casts  of  the 
uriniferous  tubules,  are  visible,  (See  Chap- 
ter IV.,  p.  96.)  When  abundant,  these  in- 
dicate an  excessive  secretion  of  mucus, 
the  result  of  irritation  of  the  urinary 
tract  (p.  99). 


ntfNE—  SUBSTANCES  IN  OR    UPON.  H9 

/?.  The  microscope  shows  SPERMATOZOA 
(bodies  resembling  tadpoles,  with  very 
elongated  tails).  (See  Chapter  IV.,  p.  100.) 
These  signify  coitus,  and,  if  very  numer- 
ous and  persistent,  Spermatorrhoea. 
Y.  FUNGOUS  GROWTHS  (generally  in  the 
form  of  cellular  bodies  from  ^7^0  to 
TTTOTnr  °f  an  mch  in  diameter,  often 
arranged  in  chains,  and  either  still  or  in 
active  vibratile  motion)  are  detected  be- 
neath the  microscope.  (See  Chapter  IV., 
p.  103.)  Their  pathological  significance 
requires  further  study  (p.  104). 
d.  In  rare  cases,  hyaline  and  pale  gran- 
ular TUBE-CASTS  may  be  detected  in  non- 
albuminous  urine  (p.  68).  Bright' s  Dis- 
ease (p.  74). 

B.   This  deposit  is  dense  and  opaque,  occupying 

considerable  bulk. 

a.  On  testing  with  heat  and  nitric  acid,  the 
supernatant  fluid  is  found  free  from  albumen. 

a.  The  deposit  let  fall  is  seen  under  the 
microscope  to  be  simply  granular.  (See 
Chapter  V.,  p.  10t).  It  consists  either  of 
amorphous  URATES  or  PHOSPHATE  OF 
LIME,  the  former  of  which  dissolve 
readily  on  heating  the  fluid,  while  the 
latter  does  not.  (See  p.  109.) 
/?.  The  sediment  is  composed  of  micro- 
scopic crystals,  triangular  prisms  and  their 
derivatives  (see  Chapter  V.,  p.  110). 
TRIPLE  PHOSPHATE  OF  AMMONIA  AND 
MAGNESIA,  Phosphuria  (p.  111). 

b.  The  reactions  of  the  urine  with  heat  and 
nitric  acid  show  the  presence  of  albumen. 


150  MEDICAL  MICROSCOPY. 

a.  The  microscopic  investigation  proves 
the  existence  of  LEUCOCYTES  (nucleated 
cells  -^LQ-  of  an  inch  in  diameter)  only. 
(See  Chapter  V.,  p.  114.)  Nephritis,  Pye- 
litis,  Cystitis,  etc.  (p.  117). 
/?.  Crystals  of  TRIPLE  PHOSPHATE  (p. 
110),  associated  with  LEUCOCYTES,  are  dis- 
covered. Chronic  cystitis,  often  dependent 
on  calculus,  is  generally  present  (p.  112) 
if  these  are  abundant. 

C.  This  deposit  appears  to  the  naked  eye  granular 
or  crystalline,  occupying  only  a  small  bulk. 

a.  The    urine    is   found   to   contain   albumen, 
under  the  tests  of  heat  and  nitric  acid. 

a.  The  microscope  proves  the  presence  of 
RED  BLOOD  CORPUSCLES  (non-nucleated 
cells  -g-^oTT  °f  an  mcn  m  diameter,  p.  121). 
Hsematuria  is  indicated  (see  p.  125). 
/9.  CANCER  CELLS  (irregular,  caudate,  and 
oval  cells  with  large  nuclei,  p.  126)  are 
seen  under  a  power  of  200  diameters. 
Carcinoma  of  some  portion  of  the  uri- 
nary tract  probably  exists  ;  but  great  care 
must  be  taken  to  avoid  mistaking  epithe- 
lial for  cancer  cells  (p.  127). 
Y.  Microscopic  examination  shows  "  TU- 
BERCLE CORPUSCLES"  (non-nucleated,  gran- 
ular, oval  bodies,  about  2170-5"  °f  an  mc^  ^n 
length,  p.  1 28)  to  exist  in  the  deposit.  Tu- 
berculosis of  the  kidney  may  be  suspected, 
according  to  some  authorities  (see  p.  128). 

b.  The  reactions  on  testing  as  above  prove  the 
urine  to  be  free  from  albumen. 

a.  Under  the  microscope  the  sediment  is 
seen  to  consist  of  OXALATE  OF  LIME  (bril- 


URINE— SUBSTANCES  IN  OR    UPON.  151 

liant  octahedral  crystals,  presenting  the 
appearance  of  squares  marked  with  diag- 
onal crosses,  or  more  rarely  in  the  form  of 
dumb-bells).  Oxaluria  (see  Chapter  VI., 
p.  129)  exists. 

ft.  The  deposit  is  found  to  be  composed  of 
URIC  ACID  (yellowish  crystals,  lozenge- 
shaped,  oval,  barrel-shaped,  etc.,  p.  132). 
Lithi-uria  (see  Chapter  VI.,  p.  134)  is 
present. 

Y.  In  rare  cases  the  deposit  may  consist 
of  microscopic  spherules  and  dumb- 
bells, soluble  with  effervescence  in  acetic 
acid.  CARBONATE  or  LIME  (see  p.  137). 

d.  Occasionally    hexagonal    crystals,    de- 
posited in  the  same  form  from  their  am- 
moniacal    solution,    are    seen    on    exam- 
ination with  the  microscope.     These  are 
CYSTINE  (see  Chapter  VI.,  p.  137).   Cysti- 
nuria. 

e.  If  the   sediment   resembles   uric  acid, 
but  is  soluble  in   hot  water  and  in  the 
mineral  acids,  it  is  composed  of  XANTHINE. 
(See  p.  138.) 

C.  Sheaf-like  bundles  or  globular  masses 
of  acicular  crystals  should  lead  us  to 
suspect  the  presence  of  TYROSINE  and 
LEUCINE  (p.  139),  and  indicate  Acute  Atro- 
phy of  the  Liver.  (Frerichs.) 
y.  If  bydatids  or  other  ENTOZOA  are  found, 
consult  Chapter  VI.,  p.  139. 

2d.  It  becomes  turbid  without  letting  fall  any  distinct 
deposit. 

A.  This  turbidity  disappears  on  warming  the  fluid. 

The   solid  matter   consists  of  amorphous  urates 

(p.  140,  and  Chapter  V.,  p.  107). 


152  MEDICAL  MICROSCOPY. 

B.  The  urine  remains  cloudy  during  the  application 
of  heat. 

a.  Microscopic  examination  reveals  YIBRIONES 
and  Bacteria  (under  a  power  of  200,  seen  as 
very  delicate  lines  from   2uVo~  ^°  Town  °f  an 
inch  in  length,  constantly  in  rapid  motion,  p. 
104).     Putrefactive  fermentation. 

b.  Under  the  microscope  the  opacity  is  seen 
to  be  due  to  multitudes  of  molecules,  too  mi- 
nute for  measurement.      Chijlous   Urine  (see 
p.  140). 

3d.  It  presents  a  delicate  FILM  floating  upon  its  sur- 
face. 

A.  Microscopic  examination  shows  the  triangular 
prisms  of  Triple  phosphate  (pp.  110  and  141),  usually 
associated  with  granular  phosphates  and  spherules 
of  urate  of  soda.     Phosphuria.     (See  Chapter  V., 
p.  112.) 

B.  Numerous   small    oil-globules    are   seen    under 
the  microscope,  associated  with  crystals  of  triple 
phosphate.    So-called  Kiestine,  by  some  considered 
an  aid  in  the  diagnosis  of  Pregnancy  (p.  141). 

It  must  not  be  forgotten,  in  making  use  of  the  above 
table  for  investigating  the  urine,  that  two,  three,  or  more 
of  the  conditions  described  may  exist  in  the  same  specimen, 
and  each  tend  to  obscure  the  characteristics  of  the  other: 
thus,  for  instance,  a  sample  of  albuminous  urine,  which 
has  been  kept  two  or  three  days  in  hot  weather,  might  be 
so  opaque  from  the  development  of  Bacteria  that  no  coagu- 
lum  could  be  detected  on  heating,  and  also  let  fall  so 
abundant  a  deposit  of  amorphous  urates  that  any  tube-casts 
which  exist  would  be  entirely  concealed.  In  such  a  case 
you  cannot  eliminate  the  consideration  of  Bright's  disease 
until  you  have  carefully  filtered  the  urine  previous  to 


URINE— SUBSTANCES  IN  OR    UPON.  153 

testing  for  albumen,  and  also  examined  a  specimen  upon 
a  slide  sufficiently  warmed  to  induce  the  fluid  to  redis- 
solve  the  urates.  Bearing*  in  mind,  however,  the  danger 
of  being  misled  by  these  accidents,  I  believe  this  scheme, 
with  the  limitations  and  exceptions  detailed  in  the  pre- 
ceding chapters  and  referred  to  by  the  pages  on  which 
they  occur,  may  be  trusted  as  a  safe  general  guide  to  the 
indications  afforded  by  the  renal  secretion. 

In  all  doubtful  cases  the  student  should  carefully  con- 
sult the  remarks  upon  extraneous  matters,  commencing 
on  p.  142. 


14 


CHAPTER    VIII. 

EXAMINATION    OF   PUS,    MUCUS,    SALIVA,    AND    MILK. 

IN  no  department  of  microscopy  have  more  important 
discoveries  been  made  within  the  last  decade  than  in  re- 
gard to  the  origin  of  Pus,  the  corpuscles  of  which,  for 
whose  diagnosis  from  mucous  and  white  blood  globules 
elaborate  directions  were  formerly  given,  are  now  proved 
by  the  ingenious  experiments  of  Prof.  Cohnheim,  of  Kiel, 
to  be  absolutely  identical  with  the  last  two  histological 
elements.  As  some  experiments  of  my  own,  in  which  I 
was  apparently  the  first  to  demonstrate  the  true  origin 
of  the  salivary  corpuscles,  strongly  corroborated  Prof. 
Cohnheim's  investigations,  by  independent  and  converging 
evidence  obtained  in  a  different  line  of  research,  I  be- 
came, as  far  as  I  am  aware,  the  earliest  advocate  of  the 
doctrine  in  this  country  (Pennsylvania  Hospital  Reports, 
January,  1869),  and  in  an  article  in  the  January  number 
of  The  American  Journal  of  the  Medical  Sciences,  for 
1810,  have  endeavored  to  elucidate,  by  its  aid,  the  true 
pathology  of  Bright's  disease.  The  following  brief  review 
of  the  subject  is  extracted  almost  verbatim  from  the  latter 
paper : 

"As,  however,  the  important  advance  in  pathological 
science,  to  which  I  have  alluded,  is  still  spoken  of  in  this 
country  under  the  title  of  '  Cohnheim's  alleged  Discovery,' 
it  may  not  be  unnecessary  to  advert  .briefly  to  its  merits 
and  the  testimony  which  supports  it.  Dr.  Cohnheim,  as 
the  readers  of  this  journal  are  aware  (see  number  for 
(154) 


EXAMINATION  OF  PUS,  MUCUS,  SALIVA,  ETC      155 

October,  1869,  pp.  549-552),  first  published  his  theory  of 
Inflammation,  and  detailed  the  original  and  ingenious  ex- 
periments from  which  it  was  built  up,  in  a  leading  article 
in  Virchow's  Archives  for  September,  1867,  which  soon 
attracted  everywhere  the  notice  of  histologists.  According 
to  Cohnheim,  the  process  of  pyogenesis  consists — first,  in 
a  partial  interruption  of  the  flow  of  blood,  by  which  the  red 
corpuscles  move  more  slowly  through,  or  almost  block 
up,  the  capillaries,  while  white  globules  adhering  to  the 
parietes  of  the  vessels  arrange  themselves  in  a  layer  upon 
this  inner  surface  of  the  walls ;  and,  second,  in  the  '  wan- 
dering out'  of  these  white  blood  cells  through  the  stomata, 
demonstrated  by  Recklinhausen  in  the  walls  of  the  finer 
blood-vessels,  by  virtue  of  that  amoeboid  movement  (see 
Fig.  15)  which  is  one  of  the  most  remarkable  attributes  of 
the  white  blood  corpuscle,  and  so  aptly  illustrated  by  an 
English  commentator  on  Prof.  Huxley's  great  lecture  upon 
Protoplasm,  when  he  explains  the  process  of  an  amoeba 
taking  a  minute  Diatom  into  its  substance  for  food,  by 
comparing  it  to  a  lump  of  dough  growing  of  itself  grad- 
ually around  an  apple  to  make  an  apple-dumpling:  the 
white  blood  corpuscles  which  have  thus  wandered  out 
then  constitute  with  exuded  serum  that  yellow  fluid  so 
long  known  under  the  name  of  pus,  and  hitherto  generally 
supposed  to  be  a  product  of  the  breaking  down  of  tissue. 
In  support  of  this  doctrine,  experiments  upon  frogs  and 
rabbits  paralyzed  by  woorara  are  described,  in  which,  the 
mesentery  of  the  animal  being  exposed  and  spread  out  upon 
the  field  of  the  microscope,  multitudes  of  white  corpuscles 
were  Keen  in  all  stages  of  transit  from  the  interior  to  the 
exterior  of  the  vascular  walls,  in  which  latter  position  they 
constituted  ordinary  pus  globules. 

"  Of  course  such  a  novelty  in  medical  science  has  met 
with  numerous  assailants,  among  whom  the  most  promi- 
nent seems  to  be  Prof.  Kolman  Balogh,  of  Pesth,  who,  in 


156  MEDICAL  MICROSCOPY. 

an  article  in  Virchow's  Archives  (Erstes  Heft,  Band  xlv. 
S.  19,  u.  s.  w.),  asserts  that  in  spite  of  the  most  prolonged 
and  careful  attention  not  once  could  he  see  the  transit  of 
the  white  blood  cells  through  the  stomata  in  the  vascular 
walls,  which  he  thinks,  if  they  exist,  are  such  minute  pores 
that  they  can  give  passage  only  to  fluids.  His  observa- 
tions are,  however,  sharply  commented  upon  by  Dr.  A. 
Schklarewski,  of  Moskow,  in  the  following  volume  of  the 
Archives  (Band  xlvi.,  Hft.  1,  S.  116),  and  Cohnheim's  ex- 
periments appear  ( Transactions  of  Pathological  Society 
of  London,,  vol.  xix  p.  467)  to  have  been  repeated  be- 
fore the  London  Pathological  Society  in  April,  1868,  by 
Dr.  H.  Charlton  Bastian,  of  London,  with  entire  success. 
In  our  own  country,  Lieutenant-Colonel  J.  J.  Woodward, 
Surgeon,  U.S.A.,  stated  during  a  lecture  at  the  Philadel- 
phia College  of  Physicians,  May  31,  1869,  that  the  experi- 
ments of  Cohnheim  had  been  tested  under  his  direction  in 
the  Surgeon-General's  office  at  Washington,  and  that  he 
had  found  the  description  of  phenomena  singularly  accu- 
rate, the  observations  on  frogs  being  fully  corroborated,  as 
far  as  they  had  time  to  repeat  them,  in  every  particular ; 
and  Dr.  William  F.  Norris,  of  this  city,  but  for  some  years 
past  residing  in  Germany,  in  an  article  now  in  press,  de- 
tailing observations  made,  chiefly  on  the  corneae  of  frogs, 
in  conjunction  with  Prof.  Strieker,  of  Vienna,  while  main- 
taining that  some  of  the  corpuscles  of  pus  originate  in  the 
proper  cells  of  the  tissue,  admits  as  indubitable  that  many 
are  in  reality  white  blood  globules  which  have  made 
their  way  through  the  walls  of  the  vessels,  as  Cohnheim 
describes. 

"It  has  been  urged,  however,  by  some  assailants  of 
this  doctrine,  that  even  admitting,  for  the  sake  of  the  argu- 
ment, Cohnheim's  views  on  inflammation  to  be  correct  as 
regards  the  inferior  animals,  upon  which  his  experiments 
were  tried,  there  is  no  proof  that  the  same  ignoble  process 


l-.YAMIXATION  OF  PUS,  MUCUS,  SALIVA,  ETC.      157 

of  suppuration  affects  man,  a  creature  of  such  far  higher 
attributes;  but  on  this  point  I  trust  that  my  own  experi- 
ments, above  referred  to,  will  be  found  conclusive.  By 
diluting  a  drop  of  my  own  blood  upon  a  slide,  with  pure 
water  introduced  at  the  margin  of  the  thin  glass  cover,  and 
thus  reducing  the  liquor  sanguinis  to  the  specific  gravity 
of  the  saliva,  I  found  it  quite  possible  to  watch  every  step 
of  the  change,  in  which  by  mere  distention  the  white  blood 
,cell  is  converted  into  the  salivary  corpuscle,  with  its  one, 
two,  or  three  nuclei,  its  actively  revolving  molecules  con- 
fined by  a  cell-wall  of  exceeding  tenuity  (see  Fig  10),  capa- 
ble of  presenting  all  the  phenomena  of  deep-staining  of  the 
nuclei  with  the  entire  cessation  of  movement  on  the  addi- 
tion of  aniline  dye.  In  like  manner,  when  the  liquor  muci 
and  liquor  puris  are  similarly  diluted  their  corpuscles  are 
also  seen  for  the  most  part  to  be  converted  into  salivary 
globules ;  and  I  infer  therefore  that  we  may  regard  the 
strong  presumption  afforded  by  Cohnheim's  experiments 
upon  the  rabbit  as  established  into  a  fact,  and  conclude 
that  most  (at  any  rate)  of  the  corpuscles  of  human  pus  are 
simply  white  blood  cells  which  have  wandered  out  through 
the  vascular  walls. 

"  But,  interesting  as  these  researches  are  from  a  scientific 
point  of  view,  it  is  only  as  they  can  be  applied  to  diseased 
states  of  the  human  organism  that  they  become  of  real 
importance  to  the  physician  ;  and  my  object  in  the  present 
paper  is  to  make  some  practical  deductions  in  regard  to 
the  congestive  and  inflammatory  processes  undergone  by 
the  kidneys  during  the  course  of  Bright's  disease." 

From  the  efforts  now  being  made  to  maintain  the  un- 
proved and  unprolific  statements  of  Addison  (1841)  and 
Waller  (1846)  as  establishing  valid  claims  to  priority  in 
this  important  discovery, — viz.,  the  origin  of  pus  in  the 
migration  of  white  blood  cells  through  the  walls  of  the 
blood-vessels  by  amoeboid  movement, — it  would  seern  that 

14* 


158  MEDICAL  MICROSCOPY. 

the  fact  itself  is  hardly  considered  any  longer  even  sub 
judice ;  indeed,  the  contest  in  regard  to  the  doctrine,  with 
some  of  its  strongest  opponents,  appears  to  be  resolving 
itself  into  a  controversy  whether  all  the  pus  globules  are 
white  blood  corpuscles  or  whether  some  of  the  former  have 
their  origin  in  the  proliferating  proper  cells  of  the  tissue  in 
which  suppuration  takes  place,  as  long  taught  by  the  great 
Berlin  pathologist.* 

It  is  obvious  that  the  changes  which  this  theory  of  the( 
origin  of  pus  will  produce  in  our  views  of  the  process  of 
inflammation,  are  so  extensive  and  wide-spread  that,  when 
fully  accepted,  whole  departments  of  pathology  must  be 
modified  in  accordance  with  its  teachings ;  and  it  seems 
probable  that  we  enjoy  as  yet  only  a  faint  glimmer  of  the 
flood  of  light  which  it  is  destined  to  throw  upon  many 
obscure  points  in  medicine  and  surgery.  In  the  preceding 
chapters  I  have  endeavored  to  make  a  few  of  its  most  ob- 
vious applications  to  the  phenomena  of  irritation  in  the 
urinary  apparatus,  and  I  trust  that  other  students  of  mi- 
croscopy may  be  induced  to  enter  also  upon  the  broad  field 
thrown  open  to  their  labors  by  Prof.  Cohnheim's  discovery. 

In  examining  a  specimen  of  fluid  supposed  to  be  or  to 
contain  Pus,  a  minute  drop  of  the  liquid  may  be  placed 
upon  the  slide,  and  if  very  thick  and  creamy,  as  in  the  so- 
called  "  laudable"  pus,  should  be  diluted  with  a  small 
quantity  of  syrup  or  glycerin  and  water,  of  the  specific 
gravity  of  blood  serum  (see  p.  31),  before  being  covered 
with  a  thin  glass ;  because,  if  this  precaution  is  not  taken, 
so  many  of  the  pus  corpuscles  overlie  each  other  in  the 
field  of  view  that  it  becomes  very  difficult  to  make  out  their 
individual  characteristics.  The  slide  thus  prepared  is  then 

*  For  further  evidence  in  favor  of  Cohnheim's  views,  see  obser- 
vations of  MM.  Vulpian  and  Hay  em,  Banking's  Half  Yearly  Ab- 
stract, July,  1870,  p.  35  (from  Gazette  Hebdomadaire,  No.  7, 
Feb.  1870)! 


OF  PUS,  MUCUS,  SALIVA,  ETC.      159 

to  be  transferred  to  the  stage  of  the  microscope,  and  may 
be  examined  with  a  power  of  200  to  1200  diameters.  As 
stated  on  page  115,  the  size  and  general  appearance  of  the 
pus  globules  will  vary  greatly,  according  to  the  specific 
gravity  of  the  liquid  in  which  they  float ;  but  in  ordinary 
laudable  pus,  diluted,  but  not  thinned,  as  above  directed, 
the  corpuscles  have  a  diameter  of  from  -^Q  to  -3-5^0  of 
an  inch,  are  generally  quite  spherical,  and  present  a  finely 
granular  or  tuberculated  surface,  of  a  grayish-white  color. 
In  regard  to  the  remarkable  amoeboid  movements  (see 
Fig.  15)  of  the  pus  corpuscles,  Dr.  Beale  observes  that,  for 
examination,  "  They  should  be  obtained  from  a  mucous  or 
other  surface  at  the  time  that  they  are  growing  and  multi- 
plying. Pus,  as  usually  examined,  consists  of  dead,  not 
of  living,  corpuscles.  These  are  spherical,  as  generally 
represented  in  books,  and  many  have  a  sharp,  well-defined 
outline,  owing  to  coagulation  having  occurred  upon  the 
surface.  Thus  the  so-called  membrane  or  cell-wall  of  the 
pus  corpuscle  has  resulted.  A  cell  membrane  may  always 
be  formed  artificially  by  exposing  the  surface  of  a  mass  of 
albuminous  material  to  the  influence  of  a  reagent,  or  to 
conditions  which  arc  known  to  effect  the  coagulation  of 
albumen.  The  best  specimens  of  pus  for  -studying  vital 
movements  may  be  obtained  from  the  urine  in  some  cases  of 
chronic  inflammation  of  the  bladder.  Not  uncommonly  in 
this  affection  the  urine  contains  very  little  solid  matter,  and 
the  pus  corpuscles  retain  their  vitality  although  immersed 
in  it  for  many  hours  after  the  urine  has  been  removed 
from  the  bladder.  So  far  from  the  corpuscles  being  spher- 
ical, as  usually  figured  and  described,  in  many  specimens 
not  a  single  corpuscle  of  this  form  is  to  be  detected.  Every 
corpuscle  exhibits  little  'buds,'  'offsets,'  or  protrusions  at 
every  part  of  its  circumference,  and  attentive  examination 
even  under  moderate  magnifying  powers  will  convince 
the  observer  that  the  corpuscles  are  slowly  undergoing 


160  MEDICAL  MICROSCOPY. 

alterations  in  form.  The  movements  are  very  remarkable." 
(Microscope  in  Practical  Medicine,  p.  63.)  I  propose  to 
consider  the  subject  of  the  amoeboid  motions  of  Leucocytes, 
as  well  as  the  proofs  (for  such  they  appear  to  me)  of  the 
existence  in  these  bodies  of  a  cell-wall  and  well-defined 
nuclei,  in  the  next  chapter,  having  introduced  the  above 
extract  here  because  of  its  more  intimate  connection  with 
the  present  subject.  The  recognition  of  this  movement 
is  very  important  in  the  diagnosis  of  Leucocytes  from 
small  epithelial  cells  or  their  isolated  nuclei,  and  of  course, 
viewing  the  "different"  corpuscles  as  identical,  it  is  by  no 
means  necessary  for  the  student  to  wait  for  some  suitable 
case  of  chronic  cystitis,  as  he  can  at  any  time  study  and 
become  familiar,  with  the  remarkable  movements  of  so- 
called  pus  corpuscles  in  a  drop  of  blood  from  his  own 
finger,  examined  upon  a  slightly-warmed  slide. 

The  bodies  which  the  young  microscopist  might  mis- 
take for  Leucocytes  are,  as  intimated  above,  small,  rounded 
epithelial  cells,  nuclei  of  epithelial  cells,  so-called  tubercle 
corpuscles,  the  cellular  elements  of  certain  morbid  growths, 
the  spores  of  torula  and  other  fungi,  and  in  the  urine 
granules  of  urates  and  of  carbonate  of  lime.  When  the 
amoeboid  movement  is  visible,  that  alone  is  sufficient  for 
diagnosis;  but  in  their  motionless  condition  some  other 
mode  of  detecting  them  is  requisite,  and  this  is  supplied  by 
their  varying  action  with  reagents.  A  favorite  test  for  the 
"  pus  corpuscle"  with  the  older  authorities  was  acetic  acid, 
on  the  addition  of  which,  according  to  Golding  Bird  (On 
Urinary  Deposits,  p.  292),  "the  interior  of  the  particle 
becomes  visible  and  is  found  to  be  filled  with  several  trans- 
parent bodies  or  nuclei.  *  *  *  Hence  pus  is 
usually  considered  a  regularly  organized  body,  consisting 
of  a  granular  membrane  enveloping  transparent  nuclei; 
being,  in  fact,  a  nucleated  cell."  I  have  found,  however, 
that  this  distention  of  the  cell-wall,  rendering  visible  the 


/•MM  .1//.V  I7YYW  OF  PUS,  MUCUS,  SALIVA,  ETC.      1G1 

contained  nuclei,  can  often  be  more  satisfactorily  shown 
to  a  student  if,  instead  of  acetic  acid,  solution  of  aniline 
!><•  introduced  at  the  margin  of  the  cover  (see  p.  45)  ;  this 
reagent  strongly  colors  the  nuclei,  while  tinting  the  deli- 
cate cell-walls  very  gently,  and  thus  brings  the  character- 
istics of  the  Leucocytes  clearly  into  view.  By  this  means 
they  may  be  distinguished  from  the  nuclei  of  epithelium, 
which,  bring  composed  entirely  of  "germinal  matter," 
become  completely  stained  of  a  deep  red  ;  from  small 
epithelial  cells  by  frequently  exhibiting  two  or  three  nuclei, 
while  epithelium,  except  in  very  rare  instances,  shows  but 
one ;  from  tubercle  corpuscles,  which,  as  a  rule,  present 
no  well-marked  nuclei ;  from  the  spores  of  fungi,  which, 
generally,  do  not  possess  nuclei;  and  from  homogeneous 
granules  of  urates  and  carbonates.  Sometimes  the  only 
way  of  diagnosticating  pus  globules  from  other  cells,  as  of 
certain  morbid  growths,  is  to  add  water  very  gradually  at 
the  edge  of  the  covering  glass  and  then  under  a  power  of 
at  least  500  watch  carefully  for  the  commencement  of  the 
molecular  movement  (see  p.  157)  so  characteristic  of  the 
salivary  corpuscular  form  (Fig.  10)  of  the  Leucocyte,  and, 
as  far  as  my  experience  goes,  occurring  in  no  other  cellular 
element  of  the  human  body  ;  although  occasionally  I  have 
seen  a  segment  of  the  membranous  envelope  of  an  epithe- 
lial cell  raised  up  from  the  substance  of  the  latter  into 
what  looked  like  an  exceedingly  delicate  bulla,  apparently 
by  the  endosmosis  of  fluid  beneath  it. 

As  stated  above,  the  Leucocytes  of  pus  present  at  first 
exactly  the  same  appearance  as  those  of  the  blood,  but 
after  a  time,  and  under  certain  conditions  not  yet  clearly 
made  out,  they  appear  to  undergo  fatty  degeneration, 
and  become  filled  with  oil  globules,  sometimes  measuring 
rdnnr  °f  aQ  mc^  across,  after  which  change  I  have  never 
seen  them  exhibit  active  amoeboid  movements.  Without 
pretending  to  decide  the  mooted  point  in  surgical  pathology, 


162  MEDICAL  MICROSCOPY. 

as  to  whether  Pus,  as  Pus,  can  be  absorbed,  I  may  state 
that  my  observations  incline  me  to  believe  that  Leucocytes 
which  have  made  their  way  out  of  the  vessels  can  proba- 
bly sometimes  re-enter  by  the  same  amoeboid  movement, 
provided  this  fatty  degeneration  has  not  taken  place.  The 
practical  results  of  treatment  of  abscesses  by  pressure  ap- 
plied early,  seem  to  confirm  such  a  view.  In  most  speci- 
mens of  pus  are  occasionally  to  be  seen  granular  corpuscles 
about  YTroTr  °f  an  mc^  *n  diameter,  which  seem  as  if  they 
might  be  formed  by  the  coalescence  of  four  or  six  ordinary 
Leucocytes,  and,  as  I  think  these  are  rare  in  mucus,  they 
may  sometimes  aid  us  in  diagnosis.  According  to  Hughes 
Bennett,  in  what  is  called  scrofulous  pus  "  the  corpuscles, 
instead  of  being  round  and  rolling  freely  upon  each  other, 
are  misshapen  and  irregular,  and  on  the  addition  of  acetic 
acid  the  granular  nuclei  are  found  to  be  ill  formed  or  ab- 
sent ;"  while  Gluge  (Pathological  Histology,  Prof.  Leidy's 
translation,  p.  48)  says  cachectic  pus  corpuscles  "  are  soft, 
liquefying  on  the  slightest  pressure,  gray,  irregular,  and  not 
sharply  defined,  but  nevertheless  their  nucleoli  are  distin- 
guishable. *  *  *  In  sanies  sometimes  Yibriones  are 
found."  Many  years  since,  Donne  announced  the  discovery 
of  immense  numbers  of  Yibriones  in  the  pus  of  chancres,  an 
observation  which  I  have  recently  confirmed  in  a  marked 
case.  The  organisms  were  very  active  and  vigorous  in 
their  movements,  but  at  the  same  time  exceedingly  minute, 
requiring  a  power  of  about  1200  for  their  examination. 

As  microscopic  observation  of  any  fluid  is  quite  power- 
less to  determine,  alone,  whether  the  Leucocytes  detected 
are  those  of  mucus  or  of  pus,  other  methods,  such  as  the 
ones  directed  on  pp  96, 114,  must  be  brought  into  requisi- 
tion ;  but  if  the  quantity  of  the  specimen  at  our  disposal 
is  very  minute,  it  may  be  altogether  impossible  to  decide 
the  question.  Of  course,  when  we  can  obtain  an  accurate 
history  of  the  case,  and  especially  if  we  remove  the  fluid 


EXAMINATION  OF  PUS,  MUCUS,  SALIVA,  ETC.      103 

ourselves  from  a  patient  and  can  thus  be  sure  that  it  has 
not  proceeded  from  any  part  covered  with  mucous  mem- 
brane, wo  may  feel  confident  of  its  nature;  but  in  exam- 
ples where  a  small  amount  of  fluid  apparently  purulent 
flows  from  a  mucous  surface,  I  am  not  aware  of  any  means 
by  which  we  can  decide  positively  whether  it  be  mucus 
9f  pus,  unless  the  occurrence  of  the  very  large  sextuple 
cells  referred  to  on  page  162  should,  on  further  investiga- 
tion, prove  characteristic.  According  to  the  theory  already 
adopted,  the  exudation  of  pus  at  any  point  indicates  that 
some  obstruction  to  the  circulation  in  the  adjacent  blood- 
vessels has  occurred  and  been  sufficient  to  allow  the  cor- 
puscles to  migrate  through  the  stomata  of  the  vascular 
walls.  The  importance  of  pus  cells  in  the  urine  has  been 
already  discussed  in  Chapter  V.,  p.  116  et  seq. 

The  examination  of  Mucus  presents  no  special  difficul- 
ties, and  is  to  be  conducted  in  a  manner  similar  to  that  ad- 
vised in  the  preceding  pages  for  the  investigation  of  pus, 
the  Leucocytes  (Fig.  15)  being  identical.  The  great  dif- 
ference between  these  two  FJG 
fluids  seems  to  consist  in 
that  the  liquor  muci  is  a  xe- 
cretion,  which,  having  been 
acted  upon  by  the  "  germi- 
nal matter"  of  the  epithelial 
cells  covering  the  base- 
ment mucous  membrane,  is 
not  albuminous,  and  conse- 

quently  gives  no  COaguluill        M^ous   CORPVSCLE    UNDERGOING   AMCE- 

With    heat    and   nitric  acid  ;     BOID  MOVEMENT.   X  2800  Diameters.  (After 

IT  •     •  Bcale.)    "From  the  mucus  of  the  throat 

while  the  liquor  puns  is  an  of  a  man  in  ,iealth.  showing  the  diffcrent 

exudation,  which,  being  the    forms  assumed  by  the  living  mass  within 

blood  serum  perhaps  driven 

between  the  scales  of  the  integument  or  hurried  through 

the  cells  of  a  raucous  membrane  without  allowing  time  for 


164  MEDICAL  MICROSCOPY. 

their  specific  action,  by  a  vis  a  tergo,  contains  albumen  that 
may  be  recognized  by  appropriate  tests.  Directions  for 
special  examination  of  mucus  in  urine  have  already  been 
given  on  p.  96,  while  for  that  of  intestinal,  vaginal,  and 
uterine  mucus  the  reader  is  referred  to  Chap.  XII. 

The  investigation  of  SALIVA  has  already  been  detailed, 
and  its  minutiae  described  as  a  subject  for  practice  by 
novices  in  the  art  of  microscopy,  so  that  I  can  hardly  give 
a  more  particular  account  of  the  exact  method  for  detect- 
ing its  normal  constituents  than  the  one  upon  page  4t. 

The  epithelial  cells  of  the  mouth,  which  are  almost 
always  present  more  or  less  abundantly  in  the  saliva, 
are  of  the  pavement  variety,  arranged  in  several  layers, 
those  in  the  deeper  strata  being  rounded,  while  the  more 
superficial  are  flattened  and  polygonal,  each  containing  a 
single  nucleus  about  the  size  of  a  red  blood  globule,  but 
oval  in  form  and  unlike  the  blood  disks,  becoming  deeply 
colored  on  the  addition  of  a  weak  Aniline  solution.  Under 
high  powers  the  older  epithelial  cells  may  often  be  seen 
filled  with  oval  and  elongated  bodies,  closely  resembling 
Bacterida,  especially  in  febrile  states  of  the  system  when 
the  tongue  is  coated  with  a  thick  "fur."  As  observed  by 
Yon  Diiben,  the  brown  tint  of  the  coating  in  typhus  and 
similar  diseases  is  caused  by  blood  derived  from  the  fis- 
sures of  the  dried  mucous  membrane. 

The  salivary  corpuscles,  whose  true  nature  I  seem  to 
have  been  the  first  to  point  out,  present  (as  described 
in  my  paper,  Identity  of  the  White  Corpuscles  of  the 
Blood  with  Salivary  Pus  and  Mucous  Corpuscles  :  Penn- 
sylvania Hospital  Reports,  Philadelphia,  1869)  under  a 
power  of  eleven  hundred  diameters  "the  appearance 
of  perfect  spheres  varying  from  the  y^j-  to  the  -^-Q 
of  an  'inch  in  diameter,  each  having  a  very  transparent 
but  beautifully  defined  cell-wall  of  exceeding  tenuity, 
which  incloses  from  one  to  four  almost  equally  trans- 


EXAMINATION  OF  PUS,  MUCUS,  SALIVA,  ETC.      KJf, 

parent  nuclei  of  a  circular  or  oval  form,  whose  diameters 
range  from  -£0Vo"  ^°  TTTOIF  °f  an  incn-  These  nuclei  are 
situated  sometimes  centrally,  but  more  commonly  near 
one  side  of  the  corpuscle,  and  the  cavity  between  the 
margin  and  the  cell-wall  is  generally  filled  with  from  25  to 
50  molecules  not  more  than  -j-o-J--^  of  an  inch  in  diameter, 
whose  characteristic  is  that  of  constant  and  rapid  motion. 
Some  of  these  molecules  seem  to  be  elongated  into  an  oval 
or  hour-glass  form ;  but  the  activity  of  their  movements 
renders  it  difficult  to  ascertain  this  with  precision.  In  my 
observations  these  corpuscles  have  appeared  to  enlarge  and 
become  flattened  from  the  pressure  of  the  glass  cover  as 
the  stratum  of  liquid  beneath  became  thinner  from  marginal 
desiccation,  so  that  usually  in  the  course  of  an  hour  or  so 
they  burst  and  discharge  about  one-fourth  of  their  contents, 
when  two,  three,  or  more  of  the  molecules  swim  away, 
continuing  their  revolving  movements  until  they  pass  out 
of  view ;  the  other  granules  outside  and  those  remaining 
within  the  cell  become  in  a  very  few  seconds  entirely  sta- 
tionary. If  a  solution  of  aniline  red  of  the  strength  of  one 
grain  to  the  ounce  of  distilled  water  be  allowed  to  pene- 
trate at  the  margin  of  the  cover,  the  nuclei  of  the  salivary 
corpuscle  are  readily  stained  of  a  bright  crimson  and  are 
thus  exhibited  with  beautiful  distinctness;  the  dye  ap- 
pears, however,  to  exert  an  immediate  influence  upon  the 
movement  of  the  molecules,  as  I  have  rarely  been  able  to 
find  cells  in  which  they  continued  to  move  after  the  nuclei 
became  at  all  colored." 

From  my  experiments  as  detailed  in  the  same  article, 
p.  253,  and  briefly  described  on  p.  157  of  this  chapter,  I 
conclude  that,  "  Tracing  now  the  white  blood  corpuscle 
from  its  condition  of  irregular  outline  and  amcebaform 
movement  as  observed  in  serum  and  in  heavy  urine  when 
the  circumambient  fluid  approaches  the  density  of  1028, 
through  its  rounded  form  with  slightly  more  distinct  nuclei 

15 


166  MEDICAL   MICROSCOPY. 

in  the  liquor  puris  and  in  urine  of  lower  specific  gravity, 
we  find  that  immersed  in  a  rarer  liquid  approximating  to 
the  mean  density  of  the  saliva  (1005)  it  has  an  accu- 
rately spherical  outline,  is  more  than  twice  the  magnitude, 
and  contains  a  number  of  minute,  actively  moving  mole- 
cules, thus  exactly  resembling  in  all  sensible  characters 
the  true  salivary  corpuscle  ;  and  it  therefore  seems  reason- 
ably certain  that  the  blood,  under  the  appointed  nervous  in- 
fluence, congesting  the  buccal  mucous  membrane  and  asso- 
ciated glands,  moves  slowly  enough  through  their  capillaries 
to  allow  some  of  its  white  globules  to  penetrate  the  walls 
of  the  vessels,  as  they  do  those  of  the  frog's  mesentery  in 
Cohnheim's  experiment  (Virchow's  Archives,  Band  xl.,  S. 
38  et  seq.),  which,  under  the  influence  of  the  rarer  saliva 
expanding  them  and  setting  free  to  move  their  contained 
molecules,  constitute  the  bodies  so  long  known  to  histola- 
gists  as  the  corpuscles  of  the  salivary  fluid." 

Among  the  abnormal  ingredients  of  the  saliva,  perhaps 
indicating  disease  of  the  mouth  and  fauces,  one  of  the 
most  common  is  the.Leptothrix  buccalis,  which,  although 
to  be  found  in  the  saliva  of  most  persons,  even  in  good 
health,  appears,  when  allowed  through  neglect  of  cleanli- 
ness to  grow  very  luxuriantly,  to  inflame  and  loosen  the 
gums  at  their  junction  with  the  teeth. 

The  spores  and  \mycelial  filaments  of  Oidium  albicans 
often  occur  in  the  saliva  of  persons  suffering  from  Aphtha? ; 
and,  according  to  some  authorities,  this  disease,  so  espe- 
cially common  in  infants  and  in  feeble  adults,  essentially 
consists  of  a  development  of  the  fungus  upon  mucous 
membranes  of  the  mouth  and  fauces,  whose  vitality  has 
become  impaired.  According  to  Yon  Diiben,  in  order  to 
detect  this  parasite  the  aphthous  patch  should  be  scraped 
with  a  scalpel,  a  portion  of  the  whitish  membrane  placed 
upon  a  slide,  moistened  with  a  drop  of  liquor  potassa, 
covered  with  thin  glass,  and  examined  with  a  power  of 


EXAMINATION  OF  PUS,  MUCUS,  SALIVA,  ETC.      167 

from  200  to  800  diameters.  The  liquor  potassa  renders 
the  epithelial  cells  very  transparent,  but  does  not  affect 
the  vegetable  structures,  so  that  the  oval  and  rounded 
spores  and  mycelial  threads,  somewhat  resembling  those 
of  the  Achorion  Schouleinii  (Fig.  26),  can  be  very  readily 
distinguished  with  the  aid  of  the  microscope.  This  author 
considers  that  "the  diagnosis  of  aphthae  from  other  djs- 
eases  of  the  oral  cavity  is  unattended  with  difficulty." 
"  Coagulated  caseine  may  present  some  striking  resem- 
blance to  aphthae,  but  its  removal  from  the  mouth  is  suf- 
ficient to  solve  all  doubts.  On  the  other  hand,  true  aphthae 
on  the  tongue,  if  not  well  developed,  may  mislead  to  the 
supposition  of  their  being  an  ordinary  lingual  coating.  An 
early  diagnosis  being  of  great  practical  moment,  in  all 
cases  of  doubt  the  microscope  should  be  promptly  resorted 
to."  In  regard  to  the  origin  of  the  fungus,  he  remarks:* 
"  Ed.  Martin,  of  Jena,  observed  exquisite  aphthae  in  the 
vagina  of  a  pregnant  woman,  who  confessed  that  her 
lover  (a  miller  by  trade)  had  introduced  his  finger,  which 
was  covered  with  flour-dust.  The  infection  had  conse- 
quently occurred  in  a  similar  mariner  as  in  infants  who 
depend  on  mealy  nutriment.  It  may  happen  that  aphthae 
and  forms  of  stomatitis  simultaneously  occur  in  a  patient, 
but  they  have  no  etiological  connection,  and  do  not  depend 
on  each  other." 

In  the  treatment  of  aphthae,  Dr.  Aitken  recommends 
borax  dissolved  in  glycerin  and  rose-water,  creasote, 
vinegar,  alcohol,  and,  in  bad  cases,  chlorate  of  potash, 
with  the  pernitrate  of  iron  internally.  He  quotes  Dr. 
Jenner  as  stating  that  "  in  cases  where  parasitic  vegetable 

*  This  remarkable  case  suggests  the  important  lesson  that  all 
farinaceous  aliments  intended  for  young  infants  should  bo 
thoroughly  cooked,  in  order  to  destroy  the  germs  of  oidium  and 
other  fungi  which  may  produce  or  aggravate  aphthae,  gastritis, 
diarrhoea,  etc. 


168  MEDICAL  MICROSCOPY. 

productions  abound,  the  application  of  a  solution  of  sul- 
phite of  soda  (5j  to  gj  of  water)  removes  the  lesion  in 
twenty-four  hours." 

Still  later  writers,  as,  for  example,  Prof.  Bamberger 
( Virchow's  Archives),  confirm  the  view  that  the  devel- 
opment of  Oidiurn  albicans  upon  the  mucous  membrane  of 
the  mouth,  pharynx,  etc.  is  the  essential  cause  of  aphthae, 
which  hence  becomes  a  purely  local  disease.  Prof.  J.  E. 
Garretson  (Diseases  and  Surgery  of  the  Mouth,  Jaws, 
and  Associated  Parts,  Phila.,  1869),  one  of  the  most  re- 
cent authorities  upon  the  subject,  maintains,  however,  on 
page  601  of  his  exhaustive  treatise,  that  "  Oidium  albicans 
is  not  a  disease,  is  not  aphtha?,  neither  is  it  the  expression 
of  disease ;  it  is  merely  a  fungous  growth,  accidentally 
associated  with  a  soil  and  circumstances  favorable  to  it  as 
a  habitat.  Aphthae  is,  without  doubt,  the  expression  of  a 
cachexia,  and  is  not  likely  to  be  a  merely  local  disease ; 
neither,  I  conceive,  is  it  possible  for  the  fungus  to  be 
peculiar  to  a  sore,  as  a  something  specific.  *  *  *  The 
microscopist,  if  I  may  be  allowed  to  suggest  it,  has  in  his 
examinations  and  conclusions  accepted  the  accident  and 
overlooked  the  true  disease."  Perhaps  the  evidence  at 
present  accumulated  is  not  sufficient  to  establish  the  fungous 
origin  of  aphtha? ;  yet,  without  claiming  any  actual  value 
for  the  analogy  as  a  proof,  it  is  interesting  to  note  here 
that  the  editors  of  the  Micrographic  Dictionary  remark,  in 
regard  to  the  Oidium  Tuckeri  (the  aphthae  of  the  vine,  if  I 
may  be  allowed  to  use  such  an  expression),  "  There  can  be 
no  doubt  whatever  in  the  minds  of  those  who  have  watched 
the  development  and  progress  of  the  vine  fungus  that  it  is 
a  cause  and  not  a  consequence  of  the  'murrain;'  still 
there  are  various  curious  circumstances  connected  with  it 
not  at  all  understood.  *  *  *  The  application  of  sul- 
phur appears  to  arrest  the  growth."  Furthermore,  in 
view  of  these  various  facts,  it  seems  wise  to  treat  aphtha? 


EXAMINATION  OF  PUS,  MUCUS,  SALIVA,  ETC.      1C!) 

(as  well  as  sundry  zymotic  diseases),  when  other  thera- 
peutic agents  fail,  more  energetically  and  hopefully  with 
the  great  parasiticides,  sulphurous  acid,  arsenic,  quinine, 
tincture  of  iron,  carbolic  acid,  etc.,  even  without  admitting 
their  fungous  origin  as  fully  proved.  But  the  whole  ques- 
tion of  parasitic  diseases  is  daily  becoming  of  greater  and 
greater  interest,  and  the  reader  is  referred  to  Chapters  IX- 
and  XIII.  for  some  further  remarks  upon  the  subject. 

The  nature  of  the  deposit  called  "  tartar"  upon  the  teeth 
was  for  a  long  time  a  mooted  point  among  scientific  ob- 
servers, but,  by  the  aid  of  careful  microscopic  investiga- 
tions, has  now  been  finally  settled. 

Herr  Shrott,  dentist,  of  Miihlhausen,  in  an  interesting 
paper  on  "  The  Inhabitants  of  the  Mouth  and  the  Teeth" 
(translated  for  the  Dental  Cosmos,  vol.  xi.  No.  1,  p.  19), 
observes,  "  The  tartar  is  also  not  formed  by  precipitate, 
as  by  precipitate  I  understand  the  separation  and  the  de- 
position of  dissolved  hard  bodies  in  any  fluid.     But  the 
tartar  is  formed  by  cultivation,  little  by  little ;  it  begins  at 
first  on  the  places  where  we  have  the  smallest  change  of 
substances, — under  the  posterior  portion  of  the  enamel  of 
the  incisors,  or  between  the  molars,  especially  where  we 
find  a  decayed  tooth,  which  prevents  the  mastication  on 
that  side.     These  places  are  also  the  true  places  of  meet- 
ing for  the  infusoria  :  here  they  remain  the  longest  time, 
obtain  their  highest  age,   die,  and  their  limy  remnants 
interlace  with  epithelial  cells,  parasites,  remains  of  food, 
slime,  and  secretion  of  saliva,  and  form  in  this  manner 
the  tartar  of  the  teeth."     Among  the  microscopic  inhab- 
itants of  the  oral  cavity  this  author  enumerates  spirilla?, 
very  abundant  in  decayed  teeth ;    amoebae  and  monads, 
often  found  beneath  artificial  sets  of  teeth  which  have  not 
been  cleaned  for  a  long  time  ;  and  denticulae  or  Protococcus 
dentalis,  very  minute  organisms,  occurring  in  great  num- 
bers in  carious  dentine. 

15* 


170  MEDICAL   MICROSCOPY. 

The  False  membrane  of  Diphtheria  is  considered  by  some 
authorities  to  be  composed  of  a  peculiar  exudation,  which, 
forming  a  favorable  nidus  for  the  development  of  fungi,  is 
often  the  seat  of  cryptogamic  growth,  whilst  other  writers 
maintain  that  the  fibrinous  material  is  only  poured  out  in 
consequence  of  the  irritation  set  up  by  a  parasitic  forma- 
tion ramifying  between  the  epithelial  layers  of  the  mucous 
membrane.  Thus,  for  example,  Dr.  Beale  remarks:  " There 
is  nothing  very  distinctive  in  the  exudation  effused  upon 
the  surface  of  the  mucous  membrane  of  the  fauces  in  cases 
of  diphtheria.  It  consists,  as  is  well  known,  of  a  white, 
soft  membrane,  varying  considerably  in  thickness.  Under 
the  microscope  this  is  found  to  be  composed  of  a  more  or 
less  transparent  viscid  substance,  about  the  consistence  of 
mucus,  and  exhibiting  the  striations  and  wavy  lines  always 
seen  in  this  material.  Sometimes  the  lines  are  so  regular 
as  to  give  to  the  specimen  a  delicately  fibrous  appearance. 
Entangled  in  this  are  found, — a,  cells  of  scaly  epithelium 
from  the  mouth  ;  b,  a  number  of  small,  transparent,  round 
or  oval  particles,  resembling  those  found  in  the  mucous 
follicles  and  in  the  deepest  layers  of  epithelium.  *  *  * 
The  small  cells  pass  into  pus  corpuscles,  and  where  the 
case  is  severe  and  the  power  of  the  patient  much  reduced 
the  number  of  these  pus-like  cells  is  very  great." 

According  to  M.  Yogel  and  Dr.  Laycock,  the  irritation 
of  the  mucous  membrane  which  gives  rise  to  exudation  is 
caused  by  the  parasitic  fungus,  Oidium  albicans,  which 
fixes  itself  upon  the  mucous  membrane  of  the  fauces. 
M.  Empis,  who  has  carefully  investigated  the  microscopic 
appearances,  asserts,  however,  that  the  former  of  these 
gentlemen  has  evidently  confounded  under  the  term 
diphtherite  all  the  pseudomembranous  exudations,  with- 
out examining  into  their  nature  or  characters,  for  this 
parasite  is  not  found  in  the  true  diphtheritic  or  fibrinous 
exudations,  but  only  in  those  of  muguet.  Dr.  L.  Letzerich, 


EXAMINATION  OF  PUS,  MUCUS,  SALIVA.   I'TC.      171 

a  recent  contributor  to  Virchow's  Archives  (Band  xlv.,  S. 
333),  concludes  from  n  series  of  observations  he  has  car- 
ried on,  that  the  fungus  (which  he  figures)  producing 
diphtheria  "belongs  to  the  Hyphomycetes,  the  family  of 
the  Cladosporium,  the  species  Zygodesmus,"  and,  in  a 
paper  in  the  following  volume  of  the  Archives,  declares 
that  from  his  two  works  on  Diphtheria  "it  is  undoubt- 
edly deduced  that  primary  epidemic  diphtheria  is  caused 
by  a  fungus  whose  spores  (contagium  vivum)  can  carry 
the  disease  to  other  individuals." 

The  examination  of  MILK  from  the  human  mamma;  may 
occasionally  assist  in  diagnosis,  first  of  blows  or  con- 
tusions of  the  breast,  and  of  incipient  mastitis  ;  and, 
second,  by  pointing  out  the  cause  of  obstinate  diarrhoea 
in  the  infant  while  nursing,  should  the  milk  be  unsuitable 
in  its  character.  A  drop  of  milk  recently  drawn  from  the 
breast  should  be  placed  upon  a  slide,  covered  with  a  thin 
glass,  and  examined  with  a  power  of  200  to  400  diameters. 
According  to  Von  Diiben,  milk  is  composed  of  plasma, 
innumerable  spherical  opaque  and  light-refracting  fat 
granules,  and  fat  drops  and  milk  globules  containing  the 
former  in  an  investment  of  what  is  probably  caseine 
(Fig.  16,  a).  Yan  Bueren,  Kolliker,  and  other  observers 
agree  that — first,  "  The  milk  globules  generate  in  the 
epithelial  cells  of  both  the  lacteal  ducts  and  terminal  vesi- 
cles, but  chiefly  in  the  latter  ;  second,  in  perfect  milk  secre- 
tion both  cell-walls  and  contents  of  the  milk  globules  dis- 
solve and  join  the  plasma;  third,  in  colostrum  this 
metamorphosis  is  not  perfect;  fourth,  the  colostrum  cor- 
puscles generate  probably  in  the  old  epithelium  of  the 
lacteal  ducts."  The  examination  of  healthy  milk  from  the 
human  female  shortly  after  childbirth  reveals,  in  addition 
to  an  abundance  of  milk  and  oil  globules,  varying  in  size 
from  the  scarcely  visible  molecule  up  to  the  y^Vir  °f  an  ^ncn 
in  diameter  (Fig.  16,  a),  numerous  colostrum  corpuscles, 


172  MEDICAL   MICROSCOPY. 

sometimes  attaining  a  diameter  of  g-J-^-  of  an   inch,  and 
strongly  resembling  other  epithelial  cells,  as  of  the  liver 
and   kidney,  which  have  under- 
gone intense  fatty  degeneration 
(Fig.   16,  b,  c,  d)  ;    these   colos- 
trum   corpuscles    generally    di- 
minish in  number   very  rapidly 
after  parturition,  although  a  few 
HUMAN  MILK,   x  200  Diameters,  may    continue     to     appear    for 
(After  Koiiiker.)  months  •  in    the    milk,    without 

C°10S-  vitiating  its  nutritious  or  whole- 
some   character.     In   some   dis- 
eases of  nursing  women,  such  as  rheumatism  and  the  ex- 
anthemata, they  continue  to  be  found  in  great  abundance, 
and  appear  to  produce  an  irritating  effect  upon  the  ali- 
mentary   canal    of    the   infant :    thus,   for   example,    Dr. 
Hughes   Bennett   relates   a   case    (Clinical   Lectures   on 
Medicine,  New  York  reprint,  1860,  p.   60)  in  which  he 
was  "  called  to  see  an  infant  a  month  old,  which  was  in  a 
state  of  considerable  emaciation,  with  constant  diarrhoea. 
The  mother,  however,  maintained  that  her  milk  was  abun- 
dant, and  that  it  was  taken  in  sufficient  quantity.     On 
being  examined  with  a  microscope,  it  was  found  to  con- 
tain numerous  compound  granular  bodies,  and  compara- 
tively few  milk  globules.     In  short,  it  presented  in  an  ex- 
aggerated degree  all  the  characters  of  colostrum,  and  this 
thirty  days  after  delivery.     It  was  evident  then  that  the 
quality  of  the  milk  was  in  fault,  an  opinion  which  was 
confirmed  by  the  recovery  of  the  infant  when  a  healthy 
nurse  was  procured."     The  existence  of  colostrum  cor- 
puscles in  the  milk  may  occasionally  be  valuable   in  a 
medico-legal   point  of   view,  as  affording   a   strong  pre- 
sumption of  recent  delivery,  which   in  a  doubtful   case 
might  be  almost  converted  into  certainty  should  they  be 
found   to   disappear    with  the   rapidity    common   in   the 


EXAMINATION  OF  PUS,  MUCUS,  SALIVA,  ETC.      173 

puerperal  state.  The  appearance  in  the  milk  of  red  blood 
corpuscles,  p.  175  (possibly  from  excoriation  of  the  nipple), 
would  be  of  course  significant  of  hemorrhage;  while  the 
presence  of  Leucocytes  (p.  95)  in  abundance,  especially  if 
associated  with  red  blood  globules,  indicates  severe  irrita- 
tion or  inflammation  of  the  mammary  gland. 

I  was  recently  consulted  in  regard  to  the  somewhat 
remarkable  case  of  a  Priniipara,  who,  after  an  attack  of 
puerperal  mastitis,  was  alarmed  at  finding  discharged 
from  the  nipple  numerous  branched  cylinders  or  "  strings" 
from  two  to  five  inches  long  and  one-sixteenth  to  three- 
sixteenths  of  an  inch  in  diameter,  which  were  pronounced 
by  her  physician,  a  provincial  practitioner,  milk-tubes 
which  had  ulcerated  out  of  the  gland.  Microscopical  ex- 
amination with  a  power  of '200,  however,  showed  that 
they  were  composed  of  an  obscurely  fibrillated  substance, 
in  which  were  occasionally  and  irregularly  imbedded  mu- 
cous corpuscles,  and  epithelial  cells  from  the  lacteal  ducts, 
thus,  of  course,  disproving  the  hypothesis  of  ulceration. 
It  has  occurred  to  me  that  these  fibrinous  casts,  not  very 
uncommon  in  the  large  intestine  (see  Chap.  XII.)  and  also 
seen  in  the  bronchial  tubes  (vide  paper  by  Stephen  Rogers, 
M.D.,  Trans.  N.  Y.  State  Med.  Soc.,  1866,  p.  41),  are 
simply  the  result  of  an  effusion  of  plastic  lymph  which 
has  been  so  intimately  associated,  molecule  by  molecule, 
as  it  was  poured  out,  with  mucus,  that  it  has  thereby  been 
prevented  from  attaching  itself  to  the  parts  from  which  it 
exudes,  and  that  this  admixture  in  its  nascent  state  with 
mucus  is  the  true  reason  why  fibrin  effused  upon  a  mucous 
surface  does  not  present  the  phenomena  seen  in  the  or- 
dinary adhesive  inflammations  of  serous  membranes. 

Since  investigating  the  above  case,  I  have  been  informed 
by  a  country  doctor  that  it  is  not  unusual  to  draw  out 
such  long  fibrinous  strings  from  the  teats  of  cows  whose 
udders  have  been  inflamed,  and  that  the  animals  generally 
recover  without  permanent  injury. 


CHAPTER  IX. 

EXAMINATION    OF   THE    BLOOD. 

SINCE  the  clinical  significance  of  pathological  alterations 
in  the  circulating  fluid  can  be  justly  appreciated  only  by 
those  who  are  familiar  with  its  physiological  characters,  I 
shall  endeavor  to  detail,  with  a  minuteness  somewhat  pro- 
portionate to  the  great  importance  of  the  subject,  the 
characteristics  of  healthy  blood,  before  attempting  to  point 
out  the  changes  which  it  undergoes  in  disease. 

As  remarked  by  Prof.  Yirchow,  we  may  consider  the 
blood  as  a  tissue  consisting  of  cells,  with  a  liquid  inter- 
cellular substance,  the  former  being  made  up  of  the  red 
and  white  corpuscles,  the  latter  of  the  blood  plasma,  or 
liquor  sanguinis,  an  aqueous  solution  of  albumen,  fibrin, 
chloride  of  sodium,  chloride  of  potassium,  and  other  saline 
constituents,  having  a  specific  gravity  of  about  1028.  Be- 
sides these,  which  are  dissolved  in  the  normal  serum,  we  find 
mentioned  by  the  editors  of  the  Micrographic  Dictionary, 
as  unusual  ingredients  of  blood — 1st.  Cells  inclosing 
colored  blood  corpuscles,  found  in  the  blood  of  the  spleen, 
liver,  etc.  2d.  Granule  cells,  either  colorless  or  contain- 
ing granules  of  pigment  (?).  3d.  Peculiar  concentric  bodies, 
three  or  four  times  as  large  as  the  colored  corpuscles  of 
the  blood,  resembling  those  found  in  the  thymus  gland. 
4th.  An  unusunlly  large  number  of  colorless  corpuscles. 
5th.  Pus  corpuscles(?).  6th.  Caudate  cells,  occasionally 
containing  pigment.  7th.  Crystals  of  hsematoidine,  at 
times  within  the  colored  corpuscles,  at  others  free.  8th. 


EXAMINATION  OF  THE  BLOOD.  175 

Two  distinct  kinds  of  a  white,  extremely  fine,  molecular 
substance  ;  one  consisting  of  fat,  the  molecular  base  of  the 
chyle,  the  other  a  very  finely  divided  albuminous  sub- 
stance. 

The  form  of  the  RED  CORPUSCLES  of  the  blood  varies  ex- 
trcinuly  in  different  classes  of  animals,  being  generally  in 
the  mammalia  circular,  flattened  disks,  the  sides  of  which 
an-  so  excavated  as  to  make  them  resemble  double-con- 
cave lenses  with  rounded  margins,  commonly  called  the 
"  water-cracker  shape,"  while  in  birds,  fishes,  and  reptiles 
they  are  usually  elliptical,  nucleated,  and  convex  upon 
their  flattened  surfaces.  The  dimensions  are  also  subject 
to  great  diversity,  those  of  the  Menobranchus  or  Proteus 
being  about  ^-0  of  an  inch  long  by  g^  of  an  inch  wide, 
while  those  of  the  musk-deer  are  said  to  measure  only 
1 2  3  2  ?'  °f  an  'ncn  acl>oss.  The  average  diameter  of  the 
human  red  blood  disks  (Fig.  17)  is  variously  stated  at 
from  -g-J-Q--^  to  -g^Vfr  °f  an  inch  >  according  to  my  own  ex- 
periments, the  mean  diameter  of  ten  corpuscles,  measured 
when  magnified  1800  times,  was  -^-j^g  of  an  inch.  As  has 
been  previously  stated  (p.  121),  they  undergo  almost  in- 
stantaneous alterations  in  shape  and  size  on  being  im- 
mersed in  liquids  which  are  rarer  or  denser  than  the 
liquor  sanguinis.  The  structure  of  the  red  blood  cor- 
puscles has  long  been  a  mooted  question  in  histology,  the 
older  doctrine  of  Schwann,  who  thought  that  they  were 
membranous  sacs  filled  with  colored  fluid,  being  now  de- 
nied by  Flint,  of  New  York,  Beale,  of  London,  and  Robin, 
of  Paris,  who  maintain  that  they  are  homogeneous,  and 
composed  of  a  soft  jelly-like  material ;  while  recent  German 
authorities,  as,  for  example,  Strieker  and  Bru'cke,  assert 
that  they  comprise  a  colorless,  porous  substance,  denomi- 
nated Oikoid,  in  whose  interstices  resides  a  colored  living 
organism,  which  they  call  the  Zooid.  From  my  own  ex- 
periments, however,  upon  the  blood  of  the  Menobranchus, 


176  MEDICAL  MICROSCOPY. 

as  well  as  upon  that  of  man,  detailed  in  a  paper  read  before 
the  Section  on  Physiology  of  the  American  Medical  Asso- 
ciation at  its  Annual  meeting  for  the  year  1870,  held  at 
Washington,  D.C.  (vide  Transactions),  I  conclude  that  the 
older  theory  in  regard  to  the  structure  of  the  red  corpus- 
cles of  the  blood,  which  teaches  that  they  are  minute 
membranous  bags  filled  with  a  colored  fluid,  explains  the 
various  phenomena  they  exhibit  more  satisfactorily  than 
does  any  other  hypothesis  which  has  hitherto  been  advanced, 
and  this  view  I  sustained  by  some  remarkable  specimens 
of  dried  blood  corpuscles  of  the  Menobranchus,  each  con- 
taining one  or  more  crystals,  composed  of  the  colored  cell 
contents,  upon  whose  points  was  propped  out  the  colorless 
cell-wall. 

A  remarkable  peculiarity  of  the  human  red  blood  glob- 
ules is  their  tendency  to  arrange  themselves  into  rows 
with  their  flat  surfaces  in  contact,  like  piles  or  rouleaux  of 
coin  (see  Fig.  17),  a  disposition  which  Robin  asserts  is 
caused  by  the  exudation  from  each  corpuscle,  as  the  blood 
cools,  of  a  glutinous  substance  (Fibrillogen)  which  causes 
them  to  adhere. 

Much  difference  of  opinion  exists  as  to  the  mode  of 
origin  of  the  red  blood  corpuscles.  Hewson  supposed 
that  they  were  formed  in  the  spleen ;  Bennett,  that  they 
resulted  from  development  of  the  nuclei  found  in  the  white 
blood  globules  ;  Flint  considers  that  they  arise  by  a  true 
genesis  in  the  sanguineous  blastema;  while  other  author- 
ities have  attributed  their  origin  to  the  lymphatic  glands. 

The  WHITE  CORPUSCLES  of  the  blood,  as  seen  in  ordinary 
serum,  are  globular  in  shape,  grayish  in  color,  and  decidedly 
larger  than  the  red  disks,  measuring  about  ^-^  of  an  inch 
in  diameter.  On  diluting  the  liquor  sanguinis  with  pure 
water  the  Leucocytes  gradually  swell  up,  one,  two,  or  three 
nuclei,  rounded  or  oval  in  form,  and  about  g-^Vo  °f  an  ^nc^ 
in  diameter,  come  into  view,  if  they  are  not  previously 


EXAMINATION  OF  THE  BLOOD.  177 

visible,  r/x  sometimes  happen*,  and  the  cavity  of  tlio  cor- 
puscle between  these  nuclei  and  the  cell-wall  is  generally 
found  to  contain  a  number  of  very  actively  moving  par- 
ticles, the  whole  putting  on,  in  fact,  the  salivary  corpus- 
cular form  of  the  Leucocyte  (Fig.  10).  If  the  serum  is 
still  further  diluted,  strong  evidence  of  a  cell-wall  is 
obtained,  as  I  describe  in  my  paper  On  the  Identity  of 
the  White  Corpuscles  of  the  Blood  with  the  Salivary 
Pus  and  Mucous  Corpuscles  (Pennsylvania  Hospital 
Reports,  1869,  p.  252);  for  the  globules  continue  to 
expand,  and  on  reaching  the  diameter  of  about  y^j-  of 
an  inch  the  specimen  then  observed  was  seen  "to  burst 
suddenly,  discharging  a  portion  of  its  contents,  whose 
outbreak  resembled  that  of  a  swarm  of  bees  from  a  hive, 
and  some  particles  of  which,  actively  revolving  as  they 
went,  swam  off  to  the  confines  of  the  field  "  When 
acted  upon  by  acetic  acid,  the  white  corpuscles  of  the 
blood  swell  up  still  more  rapidly  than  when  water  is 
employed,  and  the  nuclei  are  rendered  very  distinct.  In- 
deed, these  nuclei  are  supposed  by  Flint,  Beale,  and  others 
to  be  merely  masses  of  albumen  coagulated  by  the  reagent; 
but,  as  I  have  often  been  able  to  recognize  them  in  white 
blood  corpuscles  moving  about  in  normal  serum,  I  cannot 
consider  this  view  correct. 

One  of  the  most  remarkable  properties  of  the  white 
blood  globules  is  their  power  of  amoeboid  motion  (see  Fig. 
15),  a  movement  so  named  because  it  precisely  resembles 
that  of  the  Amoeba,  a  genus  of  Infusoria,  which  are  de- 
scribed as  follows  in  the  Micrographic  Dictionary  :  "Char- 
acters (of  the  family).  Animals  composed  of  a  glutinous 
substance,  without  integument  or  internal  structure,  con- 
stantly changing  form  by  the  protrusion  or  retraction  of 
parts  of  the  bod}7,  whence  result  variable  expansions ; 
movements  slow.  These  curious  organisms  apparently 

16 


178  MEDICAL  MICROSCOPY. 

constitute  the  simplest  forms  of  organic  beings,  for  they 
consist  of  a  single  kind  of  matter,  a  simple  mass  of  sar- 
code.  When  first  placed  upon  a  slide,  they  represent 
minute,  rounded,  semi-transparent  masses ;  but  soon  one 
or  more  rounded  or  pointed  lobes  or  transparent  expan- 
sions are  seen  to  shoot  out  from  the  margin.  These 
move  almost  imperceptibly  along  the  slide,  and,  becoming 
fixed  to  it,  slowly  draw  the  mass  to  the  fixed  point.  They 
are  usually  found  to  contain  within  them  other  Infusoria, 
Diatomacese,  Desinideaceae,  or  other  minute  Algae  serving 
as  food."  According  to  Dujardin,  the  genus  Amoeba  com- 
prises fourteen  species,  "but  the  characters  cannot  be 
depended  upon.  They  are  found  in  almost  all  infusions 
which  have  not  become  putrid,  also  in  the  slimy  debris 
covering  bodies  immersed  in  fresh  or  salt  water.  Their 
size  varies  from  JQ-  to  ^yVo  °f  an  inch."  From  this  de- 
scription it  will  be  -seen  that  the  Amoeba?  (corresponding 
to  Prof.  Huxley's  protoplasm  or  physical  basis  of  life) 
represent  vitality  in  so  undeveloped  a  form  that  each  por- 
tion of  the  organized  globule  can  successively  constitute 
itself,  or  at  least  be  constituted,  a  substitute  or  make-shift 
for  an  arm,  a  leg,  a  mouth,  a  stomach,  or  an  anus,  without 
the  existence  of  any  real  differentiation  into  those  various 
organs.  I  have  been  thus  minute  in  describing  these 
Infusoria  on  account  of  the  curious  resemblance  they  bear 
to  the  white  blood  corpuscles,  which  latter  have  acquired 
so  much  intportance  through  the  researches  of  Cohnheim 
and  the  speculations  of  HTtxley. 

The  relative  number  of  the  white  corpuscles  of  the  blood 
varies  under  different  circumstances.  Thus,  according  to 
Welker  (Handbuch  der  Lchre  von  den  Geweben,  von  S. 
Strieker,  II.  Lieferung,  Leipzig,  1869,  S.  301),  "  we  find 
one  white  corpuscle  on  an  average  to  335  red  ones ;  while 
Moleschott  states  the  proportion  as  1  to  357. 

"  The  latter  author  asserts  that  boys  have  1  colorless  to 


EXAMINATION   OF  THE  BLOOD.  179 

226  colored  blood  corpuscles ;  men,  1  to  346 ;  old  men,  1 
to  381 ;  girls,  1  to  389  ;  girls  while  menstruating,  1  to  247; 
the  same  during  the  interval,  1  to  405 ;  pregnant  females, 
1  to  281. 

"  Hirt  found  in  the  early  morning,  while  still  fasting,  1 
white  blood  corpuscle  to  716  red  ones;  half  an  hour  after 
breakfast- the  proportion  was  1  to  347  ;  two  or  three  hours 
later,  1  to  1514;  ten  minutes  after  dinner,  1  to  1592;  half 
an  hour  after  dinner,  1  to  429;  two  or  three  hours  after 
dinner,  1  to  1481  ;  half  an  hour  after  supper,  1  to  544; 
two  or  three  hours  after  supper,  1  to  1227."  According  to 
the  same  author,  the  proportion  in  the  splenic  vein  is  1  to 
60 ;  in  the  splenic  artery,  1  to  2260  ;  in  the  hepatic  vein, 
1  to  170  ;  in  the  portal  vein,  1  to  740. 

According  to  Welker  (Carpenter's  Human  Physiology, 
edited  by  Prof.  F.  Gurney  Smith,  Phila.,  1860,  p.  176),  a 
cubic  centimetre  of  human  blood  contains  4,600,000  red 
corpuscles,  so  that,  estimating  the  cubic  centimetre  as 
equal  to  -06  of  a  cubic  inch,  a  cubic  inch  as  weighing  (the 
specific  gravity  of  blood  being  1060,  and  the  weight  of  a 
cubic  inch  of  water  252*5  grains)  267*4  grains,  and  the 
body  of  a  man  weighing  140  pounds  as  being  composed  of 
one-eighth  (17^-  pounds)  of  blood,  we  find  the  total  average 
number  of  red  blood  disks  is  35,090,335,032,  and  of  white 
globules,  allowing,  as  above,  1  to  335  red  corpuscles,  is 
104,747,262. 

The  structure  of  the  white  blood  corpuscles  has  long 
been  one  of  the  questiones  vexatae  of  microscopy,  some 
authorities  considering  them  as  made  up  of  organized 
granules  which  develop  in  the  blood  plasma  and  become 
agglutinated  together ;  while  others,  as  Dr.  Beale,  look 
upon  them  in  their  normal  state  as  masses  of  structureless 
living  germinal  matter  (the  kind  of  material  which  is  alone 
concerned  in  the  production  of  everything  that  lives,  and 
always  derived  from  matter  which  existed  before  it),  the 


180  MEDICAL   MICROSCOPY. 

"granular  matter"  detected  in  them  and  supposed  to 
enter  into  the  formation  of  their  substance  being  in  fact 
only  the  debris  resulting  from  change  after  death. 

One  of  the  most  recent  writers  upon  the  subject,  Prof. 
James  Tyson,  in  his  admirable  resume  (The  Cell  Doc- 
trine, Philadelphia,  18TO,  p.  108),  asserts  that  an  opinion 
which  deems  these  granules  "  are  particles  of  formed 
material  or  extraneous  matter  suspended  in  the  formless 
substance,  just  as  granular  matter  from  without  becomes 
entangled  in  the  formless  matter  of  the  amoebae,  *  *  * 
would  be  incompatible  both  with  the  behavior  of  grow- 
ing germinal  matter,  and  the  reaction  by  which  it  is  known ; 
for  we  note,  on  the  one  hand,  that  when  germinal  matter 
grows  rapidly,  these  granules  are  the  elements  which 
increase  most  abundantly;  and,  again,  that  these  are  the 
portions  most  deeply  stained  by  ammoniacal  solutions  of 
carmine  or  aqueous  solutions  of  red  aniline,"  and  hence 
concludes,  "  We  deem  it  incorrect,  therefore,  to  describe 
germinal  matter  as  in  all  instances  structureless,  and 
prefer,  with  Robin,  to  describe  it  as  sometimes  granular." 

My  own  experiments  and  observations,  not  yet  com- 
pleted, however,  incline  me  to  the  opinion  that  the  white 
blood  corpuscles,  at  least  when  fully  developed,  are  mem- 
branous sacs  (see  p.  177),  containing  fluid  in  which  float 
numerous  molecular  masses,  and  inclosing  also  one  or 
more  nuclei,  generally  of  a  rounded  or  oval  form. 

From  the  great  increase  in  the  number  of  white  cor- 
puscles in  the  blood  of  the  splenic  vein,  it  has  been  sup- 
posed that  the  spleen  is  the  organ  chiefly  engaged  in 
their  production ;  but,  as  remarked  by  Dr.  Flint,  their 
persistence  in  animals  after  extirpation  of  the  spleen 
shows  that  they  are  developed  in  other  situations.  The 
same  distinguished  physiologist  observes,  "  The  function 
of  the  Leucocytes  is  not  understood ;  and  the  supposition 
that  they  break  down  and  become  nuclei  for  the  develop- 


/ ,M M  .J//.\ \:  T10N   OF  THE  BLOOD.  181 

incut  of  red  corpuscles,  which  at  one  time  obtained,  is  a 
pure  hypothesis,  and  lias  no  basis  in  fact." 

According  to  Dr.  E.  Neumann,  however  (Archives  die 
Heilkunde,  1869,  p.  68),  "  In  the  bones,  during  the  whole 
of  existence,  a  continual  transformation  of  lymph  cor- 
puscle-like cells  into  colored  blood  cells  occurs,"  a  con- 
version which  he  considers  to  take  place  in  the  vessels  of 
the  osseous  medulla  and  to  be  favored  by  a  decided  ob- 
struction of  the  current  of  blood.  This  process,  he  believes, 
is  accomplished  by  a  gradual  formation  of  hsemato-crys- 
talline  within  the  cell-wall  of  the  Leucocyte,  and  the  pro- 
gressive absorption  of  the  nucleus  (or  nuclei),  with  simul- 
taneous contraction  of  the  corpuscle,  to  the  size  of  the  red 
disk.  I  have  not,  however,  as  yet  seen  any  published 
observations  corroborating  the  interesting  results  at  which 
he  has  arrived. 

In  examining  the  blood  of  a  patient  microscopically,  it 
is  necessary  to  take  great  precautions  against  its  admix- 
ture with  any  extraneous  matter  'after  it  leaves  the  walls 
of  its  vessels.  In  ordinary  cases  I  have  found  it  sufficient 
to  wash  one  finger  thoroughly  with  soap  and  water,  dry  it 
with  a  new  towel,  puncture  the  ball  by  a  quick  stab,  to 
the  depth  of  an  eighth  of  an  inch,  with  a  cataract-  or  ordi- 
nary sewing-needle,  press  out  a  small  drop  of  blood,  touch 
to  it  the  middle  of  a  carefully-cleaned  slide  (taking  care 
to  avoid  bringing  the  surface  of  the  latter  in  contact  with 
any  part  of  the  bleeding  finger),  which  is  then  to  be  quickly 
covered  with  thin  glass  and  transferred  to  the  stage  of  the 
microscope,  where  a  power  of  250  diameters  will  be  found 
sufficient  to  determine  the  presence  or  absence  of  Leucocy- 
thaemia,  although  for  some  other  investigations  one  of  not 
less  tljan  1000  diameters  is  requisite.  From  my  experi- 
ments (Am.  Jour,  of  Med.  Sciences,  July,  1868)  I  am 
convinced  that  there  is  little  danger  of  contamination, 
with  ordinary  care,  from  slides  or  covers,  or  from  the 

16* 


182  MEDICAL  MICROSCOPY. 

momentary  exposure  to  the  atmosphere,  my  results  after 
soaking  the  glasses  in  strong  hydrochloric  acid  and  then 
burning  it  off  in  the  flame  of  a  spirit-lamp  being  almost 
precisely  similar  to  those  obtained  where  no  such  pre- 
cautions were  used. 

The  method  we  have  frequently  employed  in  the  Penn- 
sylvania Hospital,  being  the  one  introduced  there  by  Dr. 
J.  Forsyth  Meigs,  Senior  Attending  Physician  to  that 
Institution,  as  described  in  the  Reports  for  1868,  is  as 
follows  :  "  The  integument  (usually  under  the  edge  of  the 
scapula)  was  cleansed  with  sponge  and  towel,  and  held 
upon  the  stretch  between  two  fingers.  It  was  then  pierced 
with  the  fleam  of  a  spring  lancet,  and  (the  wound  not 
being  allowed  to  close,  but  its  lips  held  altogether  apart) 
a  little  blood  was  carefully  taken  from  the  bottom  of  the 
wedge-shaped  opening.  Admixture  with  any  elements  of 
the  epiderm  was  thus  entirely  prevented,  and  the  contents 
of  the  small  vessels  of  the  true  skin  and  subcutaneous 
tissue  obtained  pure."  Prof.  J.  H.  Salisbury,  of  Cleve- 
land, Ohio,  who  has  probably  examined  with  the  micro- 
scope more  specimens  of  blood  than  any  other  ten  phy- 
sicians in  this  country  (see  Microscopic  Examinations  of 
Blood,  New  York,  1868),  was  accustomed  to  make  a  small 
incision  in  the  external  surface  of  the  skin  upon  the  forearm, 
near  the  wrist,  and,  after  pressing  out  a  drop  of  blood,  to 
quickly  transfer  it  to  a  slide,  upon  the  point  of  the  lancet. 

In  the  investigation  of  a  specimen  of  blood  obtained  in 
either  of  these  three  methods,  one  of  the  most  important 
objects  is  perhaps  the  detection  or  exclusion  of  Leucocythae- 
mia,  an  affection  defined  by  Dr.  Aitken  to  be  "a  disease 
sui  generis,  in  which  the  number  of  white  corpuscles  in 
the  blood  is  greatly  increased,  with  a  simultaneous  diminu- 
tion of  the  red.  This  state  is  brought  about  by  chronic 
exhausting  diseases,  exposure  to  cold  and  wet,  or  serious 
acute  affections,  such  as  typhus  fever,  pneumonia,  puerperal 


EXAMINATION  OF  THE  BLOOD.  183 

fever,  affections  of  the  lymphatic  glands  or  of  the  spleen, 
and  is  attended  sometimes  by  cough  or  diarrhoea,  epistaxis, 
hcmorrlKigk1  effusions,  furunculous  or  pustulous  eruptions." 
For  this  purpose  a  definite  standard  must  be  obtained,  and 
this  is  perhaps  best  accomplished  by  testing  a  drop  of 
blood  from  some  person  in  robust  health,  and  counting  the 
average  number  of  white  globules  in  five  or  ten  fields, 
chosen  in  portions  where  the  film  is  so  thin  that  but  a  single 
layer  of  red  disks  exists  between  the  slide  and  cover.  It 
is  obvious  that,  strata  of  blood  similar  hi  thickness  being 
selected,  and  the  same  lenses  being  employed,  we  can,  by 
simply  enumerating  the  average  number  of  white  corpus- 
cles in  view  at  any  one  time,  obtain  a  very  good  estimate 
of  tjie  ratio  the  Leucocytes  of  any  particular  specimen  bear 
to  those  of  normal  blood.  Of  course,  slight  variation  in 
this  number,  unless  very  persistent,  cannot  be  esteemed  of 
importance,  since,  as  shown  by  the  table  quoted  on  p.  176 
the  white  cells  vary  within  certain  limits,  according  to  the 
time  after  taking  food,  or  rather  the  stage  of  digestion, 
and  perhaps  other  circumstances.  But  should  we  find  ten 
times  the  standard  number  of  white  corpuscles  as  the 
average  visible  in  a  field  of  view,  we  may  feel  confident  of 
the  existence  of  Leucocythaemia,  although  the  affection 
would  probably  be  in  an  incipient  stage,  since  advanced 
cases  present  the  white  globules  sometimes  equaling  the 
red  ones  in  abundance,  and  thus  several  hundred  times 
exceeding  their  ordinary  sum  total. 

The  first  discovery  of  Leucocythaemia  as  a  distinct  affec- 
tion seems  to  be  due  to  Drs.  Craige  and  Bennett,  of  Edin- 
burgh, in  1845.  They,  however,  looked  upon  it  as  a 
suppuration  of  the  blood ;  and  the  true  pathology  of  the 
disease  was  first,  and  it  appears  quite  independently, 
recognized  by  Prof.  Yirchow,  of  Berlin,  in  the  same  year. 

As  remarked  by  Dr.  Aitken,  the  increase  of  the  colorless 
corpuscles  of  the  blood,  which  is  the  prominent  character 


184  MEDICAL  MICROSCOPY. 

of  the  disease,  does  not  seem  in  any  case  to  have  existed 
or  occurred  by  itself.  Other  morbid  states  precede,  co- 
exist with,  or  succeed  the  augmentation  of  the  colorless 
corpuscles.  Of  these  complications,  enlargement  of  the 
spleen  is  the  most  common,  occurring  in  nearly  eighty  per 
cent.;  next  that  of  the  liver,  found  in  over  sixty  per  cent.; 
in  almost  one-half  the  cases  affections  of  the  lymphatic 
glands  generally  predominate ;  and  when  this  disposition 
is  associated  with  a  tendency  to  the  excessive  formation 
of  adenoid  tissue, »we  have  the  lymphatic  form  of  Leucocy- 
thaemia  described  by  Yirchow  in  1847  as  Lymphaemia. 

According  to  the  elaborate  researches  of  MM.  Ollivier 
and  Ranvier  (Archives  de  Physiologie,  tome  deuxieme 
Paris,  1869",  p.  411),  this  adenoid  tissue  appears  to  be 
composed  of  aggregated  white  blood  corpuscles  contained 
in  a  network  of  enormously  dilated  capillaries;  and  to 
the  presence  of  such  distended  blood-vessels  these  gentle- 
men attribute  the  various  symptoms,  such  as  cephalalgia, 
dyspnoea,  and  even  orthopnoea,  and  occasionally  the  haema- 
temesis  and  melaena,  occurring  in  this  affection.  Accord- 
ing to  Dr.  Aitken,  the  causes  which  bring  about  Leucocy- 
thaemia  are  entirely  unknown ;  but  it  seems  several  times 
to  have  suggested  itself  to  Yirchow  that  acute  inflam- 
matory processes  may  lay  the  foundation  of  the  morbid 
state,  and  in  an  interesting  review  of  his  writings,  in  the 
British  and  foreign  Medico- Chirurgical  Review  for  July, 
1857,  there  is  related  a  case  of  the  lymphatic  form  of  the 
disease,  whose  origin  obviously  dates  from  inflammatory 
swellings  of  the  lymphatic  glands,  after  exposure  to  cold 
and  wet.  Dr.  Aitken  saw  a  similar  case  in  Guy's  Hos- 
pital, in  July,  1863  ;  it  occurred  to  a  man  after  exposure 
to  cold  and  wet  on  Epsom  Downs  at  the  time  of  the  races 
there.  Dr.  Bennett  states,  with  regard  to  treatment,  nothing 
that  he  has  yet  tried  has  appeared  to  be  of  the  slightest 
service  in  well-marked  cases  of  Leucocythaemia  associated 


EXAMINATION  OF  THE  BLOOD.  185 

with  distinct  glandular  enlargements.  Iron,  quinine, 
chloride  of  potassium,  hydriodate  of  potash,  and  a  variety 
of  medicines,  given  internally,  with  tincture  of  iodine  ap- 
plied externally,  have  been  of  no  avail.  The  chief  indi- 
cations in  advanced  cases,  however,  will  be  found  to  be 
furnished  by  accidental  complications,  the  most  common 
of  which  are  diarrhoea  and  epistaxis,  which  require  astrin- 
gents, combined  with  tonics,  nutrients,  and  stimulants,  to 
support  the  vital  powers.  Aitken  advises  the  use  of  the 
nitro-muriatic  bath,  and  suggests  that  if  it  is  possible  to 
discover  the  glandular  or  splenic  affection  early,  before 
the  alteration  of  the  blood  has  made  much  progress,  it  is 
probable  that  the  disease  may  be  averted. 

Occasionally,  establishing  the  absence  of  Leucocythsemia 
may  give  important  aid  in  the  diagnosis  of  obscure  ab- 
dominal tumors,  as  in  the  following  case  reported  in  the 
American  Journal  of  Medical  Sciences  for  July,  1865. 
"  The  patient,  a  widow  lady,  aged  fifty  six,  consulted  me  on 
account  of  severe  pain  in  the  hypogastric  and  left  lumbar 
region,  where,  on  examination,  I  found  a  firm,  rounded 
'  mass,  which  was  nodulated  in  the  left  iliac  fossa.  Under 
proper  treatment  the  pain  was  soon  relieved,  and  during 
the  next  few  weeks  she  was  seen  and  examined  by  several 
physicians  in  consultation,  one  of  whom  felt  satisfied  that 
it  was  an  inflammation  of  the  peritoneum  investing  the 
uterus  and  ovaries ;  another,  who  has  practiced  in  this 
county  for  nearly  fifty  years,  insisted  that  it  was  an  en- 
larged spleen,  and  nothing  else ;  while  a  third,  who  did 
not  see  her,  after  a  minute  inquiry  into  all  the  symptoms, 
decided  it  was  a  uterine  growth.  It  appeared,  however, 
that  the  size  and  painless  course  of  the  tumor  rendered 
pelvic  cellulitis  improbable;  while  the  normal  length  of 
the  cavity  of  the  womb,  as  ascertained  by  Simpson's 
Uterine  sound  and  the  lateral  origin  of  the  tumor, 
negatived  the  hypothesis  of  uterine  disease.  In  regard  to 


186  MEDICAL  MICROSCOPY. 

enlargement  of  the  spleen,  although  she  had  suffered  from 
intermittent,  yet,  by  careful  percussion,  I  was  able  to  mark 
out  that  organ  in  its  normal  position,  and  the  microscope 
afforded  .additional  evidence,  by  proving  the  absence  of 
Leucocythaemia,  the  relative  number  of  the  white  and  red 
corpuscles  being  found,  on  examination,  to  retain  its 
natural  proportion.  By  these  considerations,  and  in  view 
of  the  rapid  growth  of  the  tumor,  its  bossilated  character, 
and  the  patient's  loss  of  flesh  and  strength,  I  was  led  to 
the  diagnosis  of  ovarian  dropsy,  probably  originating  in 
carcinomatous  disease," — an  opinion  which  was  fully  con- 
firmed at  the  autopsy  held  a  few  months  later,  when  the 
spleen  was  discovered  to  be  perfectly  normal  in  size,  shape, 
and  position. 

Variations  in  the  number  of  the  red  blood  corpuscles, 
which  may  be  either  increased  or  diminished,  constituting 
Polycythaemia  and  Oligocythaemia  of  Julius  Vogel,  fre- 
quently occur,  and  may  be  either  absolute  or  relative :  in 
the  former  case  the  corpuscles  are  uniformly  increased  or 
diminished  throughout  the  body  generally;  in  the  latter 
this  depends  upon  the  amount  of  water,  which,  being  less- 
or more,  alters  the  proportion  of  the  corpuscles  to  the  other 
constituents  of  the  blood.  From  some  observations  of  my 
own  upon  a  female  patient  in  the  Pennsylvania  Hospital, 
the  subject  of  profound  anaemia,  it  would  appear  that  this 
apparent  diminution  in  the  absolute  number  of  the  red 
disks  may  sometimes,  at  least,  be  the  result  simply  of  a 
loss  of  ha3mato-crystalline,  while  the  cell-walls  (see  p.  176), 
shrunken  and  distorted,  still  remain  floating  in  the  liquor 
sanguinis,  and  recognizable  when  the  blood  is  examined 
with  a  lens  of  sufficiently  high  power.  Such,  at  any  rate, 
seemed  to  be  the  case  in  the  two  examinations  I  had  an 
opportunity  of  making,  in  this  individual  (Fig.  17)  ;  but  I 
was  unfortunately  prevented,  by  her  abrupt  departure  out 
of  the  hospital,  from  observing  the  further  progress  of  her 
complaint. 


FIXATION   OF  THE  BLOOD.  1ST 

According   to   Dr.  Beale,  "in  some  cases  of  cholera, 
several  cells  much  larger  than  the  white  corpuscle  have 

FIG.  17. 


RED  BLOOD  CORPUSCLES  AND  SHRUNKEN  CELL-WALLS,  FROM  A  CASE  OP  PROFOUND 
AXJEMIA.     X  1200  Diameters. 

been  found  in  the  blood,  although  it  is  probable  that  their 
nature  is  closely  allied  to  these.  In  a  case  which  I  had 
an  opportunity  of  examining  some  years  ago,  many  of 
these  large  cells  contained  oil  globules  collected  together 
in  one  part,  leaving  the  remainder  of  the  cell  perfectly 
clear  and  transparent  as  if  the  endosmosis  of  fluid  had 
occurred.  I  have  also  seen  very  large  white  blood  cor- 
puscles in  cases  of  pya3mia." 

As  stated  by  Prof.  F.  G.  Smith  (Carpenter  on  the 
Microscope,  Philadelphia  edition,  1860),  "where  the 
blood  is  thickened  from  an  excess  of  fibrine,  the  colored 
corpuscles  become  caudate  or  flask-like  in  shape,  and  ag- 
gregate themselves  into  irregular  masses  instead  of  in  the 
form  of  rouleaux."  Such  adhesion  of  the  corpuscles  is 
said  to  be  frequently  met  with  in  cases  of  cholera.  But 
a  very  interesting  experiment,  tried,  with  true  devotion  to 


188  MEDICAL  MICROSCOPY. 

the  cause  of  science,  by  Dr.  Beale,  renders  it  extremely 
probable  that  this  peculiarity  has  no  special  relation  to 
the  disease,  but  is  due  simply  to  the  blood  being  deprived 
of  much  of  its  water.  Dr.  Beale  says :  "  One  day  I  took 
some  Epsom  salts,  which  produced  three  very  copious  liquid 
stools.  I  examined  a  drop  of  blood  from  the  finger,  and 
found  the  corpuscles  adhering  exactly  as  represented  in 
the  figure  (rendering  them  elongated  and  caudate).  I  then 
took  three  tumblers  of  warm  water,  and,  in  less  than  an 
hour  after  the  first  observation  was  made,  the  blood  cor- 
puscles exhibited  their  ordinary  characters,  forming  the 
piles  of  disks,  but  not  exhibiting  the  peculiar  tendency  to 
adhesion,  above  referred  to." 

So  much  has  been  said  in  almost  all  of  the  medical 
journals  throughout  the  civilized  world  in  regard  to  the 
alleged  discovery  claimed  to  have  been  made  by  Prof. 
Gr.  B.  Halford,  of  Melbourne,  Australia,  in  regard  to  cer- 
tain "peculiar  cells"  found  by  him  in  the  blood  of  animals 
poisoned  by  the  bites  of  venomous  serpents,  and  supposed 
to  occur  in  cases  of  cholera  and  other  rapidly  fatal  dis- 
eases, that  it  seems  worth  while  to  quote  the  results  of 
some  observations  made  in  conjunction  with  Dr.  S.  Weir 
Mitchell,  of  this  city,  on  animals  poisoned  with  rattlesnake- 
venom,  and  reported  in  the  Am.  Jour,  of  Med.  Sci.  for 
April,  1870,  as  follows,  viz.:  "  Proceeding  now  to  group 
together  the  results  of  these  experiments,  it  will  be  seen 
that  in  the  examples  of  a  rabbit,  dog,  and  goat  so  poisoned 
by  rattlesnake-venom  as  to  survive  its  insertion  from  one 
to  six  hours  only,  whose  hearts  were  allowed  to  remain 
unopened  from  twelve  to  twenty-four  hours  after  death, 
the  temperature  varying  from  75°  to  90°  Fahrenheit,  the 
blood,  when  removed  from  the  cardiac  cavities  in  such  a 
way  as  to  avoid  all  contamination,  and  carefully  examined 
with  a  high  power  (one  twenty-fifth1  inch  objective),  ex- 
hibited cells  corresponding  perfectly  to  those  described  by 


EXAMINATION   OF  THE  BLOOD.  lx<) 

Prof.  Hal  ford.  Yet  these  so-called  'peculiar'  cells  were 
always  mingled  not  only  with  white  blood  corpuscles  in 
their  ordinary  '  pearly  and  opaque'  condition,  hut  also 
witli  those  in  various  stages  of  enlargement,  an  alteration 
such  as  maybe  at  any  time  produced  in  the  white  globules 
of  normal  blood  simply  by  diluting  the  liquor  sanguinis 
wit  h  water.  And,  further,  that  in  the  case  of  the  goat,  when 
a  majority  of  the  'peculiar  cells'  presented  the  unusual 
character  of  being  multi- nucleated,  the  white  blood  glob- 
ules, if  distended  by  water,  exhibited  the  same  peculiarity. 
W<-  may  therefore,  I  think,  fairly  conclude  that  the  ab- 
normal corpuscles  in  these  particular  instances  were  in 
reality  only  white  blood  globules  which  had  undergone  a 
change  similar  to  that  caused  by  reducing  the  specific 
gravity  of  the  blood,  and  so  establish  a  strong  presumption 
(whose  correctness  Prof.  Hal  ford  can  alone  decide)  that 
the  '  peculiar  cells'  described  by  him  as  resulting  from  the 
poison  of  snake-bites  are  precisely  analogous  in  their 
character." 

A  third  form  of  abnormal  variation  in  the  appearance  of 
the  blood  under  the  microscope  is  a  preponderance  of  the 
molecular  substance  (the  globulin  of  Donne),  which  is 
naturally  abundant  after  full  meals  of  fatty  food,  and  said 
also  to  occur  in  abundance  during  long  fasting,  pregnancy, 
the  use  of  spirituous  liquors,  and  in  the  course  of  Bright's 
disease;  constituting  the  so-called  GalactaBmia  or  Lipaemia. 
When  coagulation  takes  place  in  blood  drawn  by  venesec- 
tion from  patients  so  affected,  these  molecules  are  found 
chiefly  in  the  liquor  sanguiuis,  to  which  they  impart  a 
milky  or  turbid  appearance.  According  to  Yon  Du'ben, 
their  presence  in  the  blood  indicates  imperfect  ha3matosis 
and  assimilation,  and  perhaps  inefficient  purification  of  the 
blood  by  the  secretory  and  excretory  organs. 

Modifications  in  the  quantity  and  probably  the  constitu- 
tion of  the  FIBRINE  of  the  blood  (Fig.  18)  may  be  readily 

17 


190  MEDICAL  MICROSCOPY. 

recognized  under  a  good  objective,  as  appears  to  have  been 
first  demonstrated,  in  this  country  at  least,  by  Prof.  Salis- 
bury, of  Cleveland,  Ohio  (see  Microscopic  Examinations  of 
Blood,  New  York,  1868,  p.  15).  He  states  that  "  In  rheu- 
matic conditions  the  filaments  of  the  fibrine  network  of  the 
blood  are  in  a  tonic  state  of  contraction  ;  this  increases  the 
size  of  the  filaments,  making  them  more  plainly  visible,  and 
decreases  the  size  of  the  meshes,  so  that  the  blood  is  in  the 
premonitory  stage  of  clotting ;  the  meshes  being  so  small 
that  they  interfere  with  the  free  passage  of  the  blood- 
elements,  they  holding  partially  in  their  meshes  the  colored 
and  colorless  corpuscles.  This  makes  the  blood  have  a 
ropy,  half-clotted  appearance  between  the  slides.  In  a  few 
minutes  after  rheumatic  blood  is  placed  between  the  slides, 
the  colorless  and  colored  corpuscles  arrange  themselves  in 
ropy  rows  and  masses,  leaving  large,  irregular,  clear  spaces, 

FIG.  18. 


APPEARANCE  AND  ARRANGEMENT  OF  THE  FIBRINE  FILAMENTS  OF  BLOOD  IN  HEALTH. 
(After  Salisbury.)     X  200  Diameters. 

in  which  may  be  distinctly  traced  the  mesh-work  of  fibrine 
filaments.  Frequently,  for  months  before  the  patient  has 
any  idea  that  he  is  rheumatic,  or  in  danger  of  being  at  any 


EXAMINATION  OF  Till']  BLOOD.  191 

moment  taken  suddenly  down  with  rheumatism,  this  condi- 
tion may  be  positively  diagnosticated  by  the  appearance  and 
condition  of  the  blood."  The  same  author  further  remarks 
(and  this  statement  I  have  verified  by  repeated  observa- 
tions) that  the  network  of  fibrine  is  much  more  distinct  in 
specimens  of  blood  drawn  from  patients  affected  with  pulmo- 
nary tuberculosis,  pneumonia,  and  probably  other  inflamma- 
tory diseases.  It  has  occurred  to  me  that  this  method  of 
investigating  the  blood  for  the  detection  of  fibrine  filaments 
might  sometimes  be  very  useful  in  recognizing  the  hem- 
orrhagic  diathesis,  and  so  determining  the  propriety  or 
otherwise  of  resorting  to  any  surgical  operation,  how- 
ever trivial  (the  simple  extraction  of  a  tooth  having  proved 
fatal),  in  patients  who  are  the  subjects  of  this  remarkable 
idiosyncrasy.  Niemeyer  (Text-Book  of  Practical  Medi- 
cine, Humphrey's  and  Hackley's  translation,  New  York, 
1869,  vol.  ii.  p.  736)  observes  that  Haemophilia  or  Haemor- 
rhaphilia  (the  malady  above  referred  to)  is  distinguished 
by  an  unusual  obstinacy  of  traumatic  hemorrhage,  or  a 
tendency  to  spontaneous  bleedings  ;  also,  that  no  anatomical 
abnormity  can  be  discovered;  and  the  complaint  is  gen- 
erally hereditary,  although  it  often  does  not  shew  itself 
until  the  sixth  or  eighth  year  of  life.  In  its  treatment  he 
recommends  Glauber's  salts,  in  cathartic  doses,  and  asserts 
that  from  two  to  five  grains  of  Secale  cornutum,  adminis- 
tered every  half-hour,  have  been  of  much  service. 

Dr.  Hughes  Bennett  narrates  the  case  of  a  woman 
who  died  of  cholera,  exhibiting  a  remarkable  alteration  in 
the  blood :  "  It  consisted  in  the  colored  corpuscles  being 
paler  than  usual  and  the  colorless  ones  normal ;  but  min- 
gled with  these  were  others,  varying  in  shape  and  size. 
They  were  generally  circular,  but  some  were  oval  and  a 
few  caudate ;  they  had  a  well-defined  external  smooth 
border,  having  one  or  two  bright  refracting  granules,  gen- 
erally situated  in  the  external  membrane  and  occasionally 


192  MEDICAL   MICROSCOPY. 

projecting  from  it.  When  seen  edgeways,  they  were  flat- 
tened, and  existed  in  the  proportion  of  one  to  seven  of  the 
colored  corpuscles.  Their  long  diameter  varied  from  y-^Vo* 
to  the  2-oVo~  of  an  inch,  and  their  transverse  diameter  from 
the  2oV(y  to  4^00  °f  an  inch.  The  addition  of  acetic  acid 
caused  them  to  swell  out,  dissolved  their  external  wall, 
and  liberated  the  granules;  aqua  potassse  rendered  the 
whole  structure  paler;  and  a  solution  of  muriate  of  soda 
rendered  them  more  distinct  and  of  smaller  size." 

In  certain  internal  hemorrhages,  according  to  the  same 
author,  the  red  corpuscles  break  down  after  remaining 
(without  the  effused  blood  being  absorbed)  for  a  consider- 
able length  of  time,  or  become  partly  dissolved,  when  the 
external  envelope  is  seen  to  be  very  transparent,  apparently 
containing  one  or  several  granules.  The  same  change  is 
observed  in  blood  extravasated  beneath  the  skin  in  scurvy 
or  purpura,  and,  as  I  have  recently  observed,  in  retained 
fluid  of  cases  of  Suppressio  Mensium.  (See  Chap.  XII.) 

Among  the  foreign  elements  in  the  blood,  epithelial  cells 
from  the  mucous  membrane  lining  the  blood-vessels  have 
been  found,  and  Joseph  Meyer  is  said  to  have  seen  them 
in  the  circulating  blood  of  a  frog,  while  Yirchow  reports 
observing  oblong  epithelial  cells,  containing  fatty  and  pig- 
ment molecules,  in  bodies  of  patients  who  had  died  of 
intermittent  fever  and  cancer  of  the  womb ;  Mackall  has 
seen  pigment  cells,  and  Frericbs  asserts  that  pigment 
granules,  in  flakes  and  scales  or  contained  in  cells  of  very 
irregular  rounded  or  sharp  outlines,  are  common  in  the 
blood  of  malarial  disease.  Bonders  and  Yogel  suggest 
the  possibility  of  epithelial  cell?,  aggregated  together  in 
the  blood's  stream,  becoming  impacted  in  the  smaller 
arterial  twigs,  where  they  give  rise  to  thrombosis  and  the 
formation  of  abscesses  of  the  blood-vessels,  so  frequent  in 
puerperal  and  pyaBmic  fever. 

The  occasional  presence  of  cancer  cells  circulating  in 


EXAMINATION  OF  THE  BLOOD.  193 

the  blood  has  been  maintained  by  such  high  authorities  as 
Virchow,  Bennett,  Paget,  and  Quekett;  but,  if  they  do 
exist,  it  is  so  rarely  that  the  fact  is  probably  devoid  of 
practical  importance,  and  it  seems  possible  that  epithelium 
from  the  mucous  coat  of  the  arterioles  may  have  been 
mistaken  for  the  cells  of  carcinoma. 

Von  Diiben  states  that  in  the  blood  of  certain  quadru- 
peds Entozoa  are  constant  elements ;  as,  for  example, 
FilariaB  in  dogs,  Strongylus  armatus  in  the  horse,  etc. ; 
and  the  same  has  been  asserted  of  human  blood,  Duval 
professing  to  have  seen  Fasciolae  in  the  portal  vein  ;  Brau- 
ell  states  positively  that  he  has  observed  Vibriones  in 
the  blood  of  glandered  horses,  and  more  recently  M.  Da- 
vaine,  of  Paris,  has  announced  the  discovery  of  Bacteria 
in  the  blood  of  both  man  and  the  inferior  animals  affected 
with  carbuncle  and  malignant  pustule,  although  my  own 
researches  tend  to  show  that  such  Infusoria  exist,  at  least 
in  small  numbers  and  a  rudimentary  form,  in  the  blood  of 
persons  enjoying  ordinary  health  (see  my  paper  entitled 
"  Experiments  showing  the  Occurrence  of  Vegetable  Or- 
ganisms in  Human  Blood,"  American  Journal  of  Medical 
Sciences,  July,  1868).  The  development  of  the  Bilharzia 
haematobia,  and  perhaps  the  B.  capensis,  in  the  portal 
veins  of  patients  suffering  from  an  epidemic  dysentery  and 
haematuria  very  common  in  Egypt,  at  the  Cape  of  Good 
Hope,  and  at  Natal,  is  now  so  well  authenticated  that  it 
seems  to  be  beyond  dispute.  According  to  Professors 
Bilharz  and  Griesinger,  the  ova  of  this  parasite  have  been 
met  with  in  the  parenchyma  of  the  liver,  the  membranes 
of  the  small  intestines,  but  especially  in  the  submucous 
cellular  tissue  of  the  bladder,  the  ureters,  seminal  vesicles, 
sigmoid  flexure,  and  rectum.  Professor  W.  Griesinger 
explains  the  deposits  of  the  ova  in  the  uro-genital  organs, 
particularly  in  the  polypous  vegetations  of  their  mucous 
membrane,  sometimes  incrusted  with  urinary  deposits,  by 

17* 


194  MEDICAL  MICROSCOPY. 

supposing  that  "the  male,  bearing  an  impregnated  female 
in  his  canalis  gynocopherus,  forces  itself  against  the  cur- 
rent of  the  blood  into  the  smaller  branches  of  the  venous 
plexus ;  with  the  aid  of  its  locomotory  apparatus,  con- 
sisting of  sunken  disks  and  minute  bristles,  it  works  its 
way  and  deposits  its  ova,  which  are  united  into  lumps  by 
a  gelatinous  substance,  within  the  capillaries.  Passive 
hyperaemia,  stasis,  and  effusion  of  plastic  lymph  ensue, 
the  vessels  burst,  and  thus  the  ova  are  placed  into  cel- 
lular tissue,  from  which  they  pass  to  the  surface  of  the 
mucous  membrane  lining  the  bladder  or  are  discharged 
with  the  urine." 

Professor  Lionel  Beale  is  led  to  believe,  through  his  re- 
searches upon  the  cattle-plague,  that  the  presence  of  numer- 
ous masses  of  germinal  matter  (contagium)  introduced  from 
without  into  diseased  blood  and  of  products  resulting  from 
their  death  and  decay  may  give  rise  by  their  multiplication 
in  the  capillaries  to  circumscribed  local  congestions,  which 
result  in  the  production  of  various  peculiar  eruptions  and 
rashes.  "  In  many  cases  the  congestion  ends  in  complete 
stagnation  followed  by  suppuration  (boil,  carbuncle,  pus- 
tule) and  the  death,  destruction,  and  removal  of  the  portion 
of  tissue  affected ;  or  it  is  followed  by  the  esca.pe  from  the 
blood  and  lymphatics  of  serum  and  small  particles  of 
germinal  matter,  which  multiply  for  a  time  in  the  sub- 
stance of  the  cuticle,  the  superficial  portion  of  which  is 
elevated  (vesicle,  bulla),  the  fluid  and  corpuscles  drying 
up  and  forming  with  the  altered  cuticle  and  secretion  of 
the  sebaceous  glands  a  scab  or  crust;  or  a  raw,  moist  sur- 
face which  does  not  readily  heal,  known  as  an  ulcer,  is 
formed  beneath  the  detached  layer  of  cuticle."  Dr.  Beale 
further  states  that,  although  difficult,  he  has  "  succeeded, 
by  squeezing  the  blood  from  the  capillaries  toward  an 
opening  in  a  vein,  in  obtaining  clots  with  numerous  parti- 
cles of  germinal  matter." 


EXAMINATION  OF  THE  BLOOD.  195 

Dr.  Sansom,  whose  excellent  monograph  (Chloroform, 
its  Actions  and  Administrations)  has  rendered  him  so 
well  known  in  this  country  as  well  as  in  his  own,  ap- 
pears to  have  been  led  by  some  of  his  experiments  to 
suspect  that  chloroform  during  its  inhalation  had  a 'spe- 
cifically destructive  effect  upon  the  red  blood  corpuscles ; 
but  Dr.  J.  H.  McQuillen,  Professor  of  Physiology  in  the 
Philadelphia  Dental  College,  has  shown  by  an  elaborate 
series  of  observations  upon  the  blood  of  human  beings 
and  various  inferior  animals  before,  during,  and  subsequent 
to  the  existence  of  chloroform  narcotization,  that  no  visible 
change  in  the  aspect  of  the  red  disks  takes  place.  (  Vide 
Dental  Cosmos,  March,  1869.) 

It  would  be  manifestly  improper,  in  such  a  work  as  the 
present,  to  enter  upon  the  discussion  of  the  origin  in  the 
blood  of  zymotic  diseases  from  fungous  growths,  especially 
as  the  weight  of  authority  is  still  so  ponderous  against  its 
recognition.  Suffice  it  to  say  that,  on  the  one  hand,  among 
others  Salisbury,  of  Cleveland,  Ohio,  maintains  that  inter- 
mittent fever,  enteric  fever,  and  small-pox  are  produced  by 
fungi,  which  he  has  named  Gemiasma  viridis,  etc.,  Byolysis 
tj^phoides,  and  los  variolosa  respectively ;  Hallier  of  Jena 
advances  the  theory  that  cholera  is  caused  by  a  peculiar  de- 
velopment of  his  so-called  micrococcus,  and,  in  conjunction 
with  Dr.  Stiles  (Third  Annual  Report  of  the  Metropolitan 
Board  of  Health  of  the  State  of  New  York,  p.  311  et  seq.), 
attributes  the  Texas  cattle-disease  to  the  Coniothecium  Sti- 
lesianum,  and  Davaine  of  Paris  asserts  that  carbuncle  and 
malignant  pustule  have  their  origin  in  the  growth  of  Bac- 
teria and  Bacterida  in  the  blood  ;  while,  on  the  other  hand, 
Prof.  H.  C.  Wood,  Jr.,  of  this  city,  in  an  able  article,*  ple- 
thoric with  negative  evidence,  denies  that  there  are  any 
known  facts  establishing  the  doctrine  of  animate  contagion, 

*  American  Journal  of  Medical  Sciences,  Oct.  1868,  p.  352. 


196  MEDICAL  MICROSCOPY. 

and  Drs.  Billings  and  Curtis,  in  their  report  on  the  asserted 
causation  of  some  cattle-diseases  by  fungi,*  as  a  result  of 
their  elaborate  and  ingenious  experiments,  declare  that 
they  have  failed  to  establish  the  presence  of  any  peculiar 
or  special  cryptogamic  germs  in  the  blood.  Nevertheless, 
when  we  remember  that  the  great  law  of  Nature's  econ- 
omy appears  to  be  a  never-ending  struggle  (wherever 
possible)  of  each  organism  and  every  class  of  organisms 
for  its  own  existence  against  every  other  form  of  life, 
and  recall  the  fact  that  in  the  vegetable  world  such  devas- 
tating plagues  originate  in  the  growth  of  the  cryptogams 
which  produce  the  vine-blight,  the  potato-rot,  and  rust 
and  smut  in  the  cereals,  it  seems  highly  probable  that 
some  (perhaps  the  same)  minute  organic  entities,  con- 
temptible in  their  immeasurable  minuteness  but  terrible 
in  their  almost  infinite  number,  do  possess  like  destructive 
powers  over  the  animal  kingdom;  and  that  their  discovery, 
when  made,  if  it  be  not  already  accomplished,  will  ulti- 
mately enable  us,  far  better  than  ever  before,  to  struggle 
with  disease.  At  present,  however,  proofs  of  such  a 
theory  seem  to  extend  no  further  than  the  facts — first,  that 
Bacteria  develop  in  blood  which  has  been  drawn  from  the 
vessels,  absolutely  without  exposure  to  the  air,  as  shown 
by  the  observations  of  Frau  Liiders,  of  Kiel,  admitted  by 
Prof.  H.  C.  Wood,  Jr.,  and  confirmed  by  Drs.  Billings  and 
Curtis ;  and,  second,  that  Bacteria  taken  into  the  stomach 
may  pass  from  thence  into  the  blood,  as  occurred  in  ex- 
periments upon  myself,  detailed  before  the  Central  New 
York  Medical  Association  at  Rochester,  June,  1868,  pub- 
lished in  the  American  Journal  of  Medical  Sciences  for 
July  of  the  same  year,  and  corroborated  by  Dr.  W.  Neftel 
in  the  New  York  Medical  Record  of  July  15,  1868. 
Beside  and  beyond  all  this,  however,  should  the  preg- 

.    *  American  Journal  of  Medical  Sciences,  Oct.  1869,  p.  526. 


EXAMINATION  OF  THE  BLOOD.  107 

mint  doctrine  of  Heterogeny,  as  advanced  and  ably  main- 
tained by  Pouchet,  Pennetier,  Mantegazza,  and  their 
disciples,  be  at  some  future  time  fully  demonstrated,  it 
must  largely  modify  any  view  of  the  parasitic  origin  of 
diseases.* 


*  Whilst  these  pages  are  passing  through  the  press,  I  find  the 
Lancet  of  July  9,  1870.  announces  that  Dr.  H.  Charlton  Bastian, 
of  London,  has  in  preparation  a  work  on  Spontaneous  Generation 
(portions  of  which  he  has  already  published),  whose  object  is  to 
demonstrate  by  elaborate  series  of  experiments  "  that  low  forms 
of  life  become  developed  in  organic  fluids  without  the  presence 
of  air,  absolutely  in  vacuo,  and  in  fluids  that  have  been  previously 
raised  to  temperatures  that  have  been  universally  admitted  to  be 
destructive  to  the  vitality  of  all  known  germs  ;  and  not  in  organic 
fluids  only,  but  in  saline  solutions,  and  in  saline  solutions  contain- 
ing no  carbon,  and  in  which  that  element  has  been  replaced  by 
silicon.  Such  results,  when  the  experiments  producing  them  have 
been  properly  repeated  and  tested  by  other  observers,  will  go  far 
to  strike  at  the  root  of  whole  systems  of  thought  that  arc  at  present 
cherished  by  large  numbers  of  earnest  people.  And  yet,  as  we  have 
often  had  occasion  to  maintain,  the  doctrine  of  germs,  and  es- 
pecially of  the  germinal  origin  of  disease,  almost  requires  the 
doctrine  of  spontaneous  germination  as  its  complement,"  etc. 


CHAPTER   X. 

EXAMINATION   OF    SPUTUM    IN   PHTHISIS,  ETC. 

THE  diagnostic  importance  of  the  sputa  when  subjected 
to  microscopic  investigation  has  long  been  admitted,  but 
this  value  has  been  greatly  increased  by  Dr.  Fen  wick's 
invention  of  a  method  by  which  the  fragments  of  lung- 
tissue  separated  in  the  pulmonary  ulcerations  of  phthisis 
and  tuberculosis  can  be  readily  recognized.  There  is  no 
doubt  that  we  are  in  this  way  sometimes  enabled  to  de- 
tect tubercular  consumption  during  an  early  period  of  the 
attack,  and  at  a  time  when  the  signs  and  symptoms,  with- 
out its  aid,  are  still  inconclusive. 

The  microscopist  who  attempts  to  derive  assistance 
from  the  examination  of  sputum,  as  ejected  from  the 
mouth,  should  first  render  himself  familiar  with  the  usual 
appearance  of  ordinary  expectoration  as  it  becomes  mixed 
with  the  various  normal  and  accidental  contents  of  the 
oral  cavity,  which  object  can  only  be  accomplished  by 
careful  and  oft-repeated  investigations  of  these  matters 
obtained  from  healthy  individuals.  Besides  the  ingre- 
dients and  impurities  of  saliva  described  in  Chapter  VIII. 
(page  164  et  seq.),  and  comprising  salivary  corpuscles, 
epithelial  cells  from  the  buccal  and  lingual  mucous  mem- 
branes, filaments  and  spores  of  the  Leptothrix  buccalis 
and  other  fungi,  articles  of  food,  such  as  starch  cor- 
puscles, portions  of  striated  muscle,  fragments  of  cellulose 
and  other  vegetable  tissues,  etc.,  we  may  expect  to  find 
specimens  of  the  great  variety  of  substances  constantly 
(198) 


EXAMINATION  OF  SPUTUM  IN  PHTHISIS,  ETC.      199 

floating1  in  the  atmosphere  and  inhaled  with  it  into  the  lunpr, 
such  as  particles  of  hair,  wool,  dust,  feathers,  carbon,  pollen- 
grains,  etc.,  all  of  which  render  the  examination  of  sputum 
one  of  the  most  difficult  although  one  of  the  most  in- 
structive as  a  study  to  the  microscopist  that  can  be  under- 
taken. When  investigating  the  contents  of  sputum  as 
expectorated,  it  is  necessary  to  examine  different  specimens 
from  various  parts  of  the  mass,  especially  those  which  to 
the  naked  eye  or  a  hand  magnifying  glass  appear  to  vary 
in  constitution,  as  the  minute  fragments  of  some  particular 
ingredient  searched  for  may  otherwise  escape  detection. 
It  is  recommended  by  Dr.  Hughes  Bennett,  and  some 
other  authorities,  that  the  sputa  tinder  consideration 
should  be  stirred  up  with  a  considerable  bulk  of  water,  in 
order  that  certain  portions  may  be  selected  as  objects  of 
research  ;  but  Prof.  Beale  objects  to  this  method,  on  the 
ground  that  the  admixture  of  water  necessarily  causes  a 
physical  alteration  of  many  of  the  cells  and  produces  com- 
plete disintegration  of  others.  Such  inconvenience  may, 
however,  be  entirely  obviated  by  employing  as  a  men- 
struum, instead  of  water,  the  weak  syrup  suggested  on 
page  37  (but  without  carbolic  acid),  or  the  dilute  glycerin; 
and  this  method  will,  I  think,  often  be  found  the  preferable 
one  to  pursue.  Much  difficulty  is  frequently  experienced 
in  separating  small  pieces  of  viscid  sputum  from  a  tena- 
cious mass,  and  repeated  efforts  must  often  be  made  before 
this  can  be  accomplished.  Dr.  Beale  describes  a  peculiar 
pair  of  forceps,  having  their  blades  cup-shaped  at  the  ex- 
tremities, which  he  thinks  partly  overcome  this  obstacle ; 
but,  as  a  general  rule,  the  ordinary  forceps  and  scissors  of 
the  dissecting-case  may  be  made  to  answer  every  pur- 
pose. A  few  drops  of  the  syrup  above  mentioned  should 
be  added  to  the  more  opaque  specimens,  as  placed  upon 
the  slide,  the  mass  torn  out  with  the  mounted  needles,  so 
as  to  form  a  thin  film,  with  ragged  edges,  when  the  glass 


200  MEDICAL  MICROSCOPY. 

cover  is  applied,  and  pressed  down  with  moderate  firm- 
ness. On  placing  a  slide  so  prepared  upon  the  stage  of 
the  microscope,  and  examining  with  a  power  of  200  diam- 
eters, the  more  or  less  distinctly  fibrillated  mucin,  which 
forms  -the  balk  of  expectorated  material  as  ejected  from 
the  trachea  of  an  individual  whose  pulmonary  organs  are 
healthy  or  nearly  so,  can  generally  be  clearly  seen,  and 
imbedded  in  it  may  often  be  observed  the  so-called  mucous 
corpuscles  (Leucocytes,  vide  Chapter  VIII.),  exhibiting 
more  or  less  active  amoeboid  movements  (Fig.  15). 

The  expectoration  which  forms  one  of  the  most  promi- 
nent and  distressing  symptoms  of  hydrophobia  consists 
of  a  dense,  tenacious  mucus,  the  Leucocytes  of  which  ap- 
peared to  me  to  have  undergone  a  species  of  fatty  de- 
generation, in  a  well-marked  instance  treated  in  the  Penn- 
sylvania. Hospital  during  the  summer  of  1869,  by  Dr.  J. 
Forsyth  Meigs,  Senior  Attending  Physician,  who  will 
probably  publish  a  complete  history  of  the  case  in  an  early 
number  of  the  Philadelphia  Medical  Times. 

If  a  specimen  of  sputum  thus  examined  is  found  to 
contain  a  large  number  of  Leucocytes,  it  affords  a  strong- 
evidence  that  irritation  of  the  mucous  membrane  lining 
the  bronchia  exists  to  such  an  extent  as  to  cause  a  more  or 
less  serious  impediment  to  the  circulation  of  blood  in  the 
vascular  network  beneath  the  epithelial  layer.  And, 
again,  should  the  expectorated  matter  be  composed  chiefly 
of  Leucocytes,  with  a  few  red  blood  disks  intermingled, 
we  may  conclude  (unless  some  hemorrhage  has  occurred) 
that  a  true  inflammation  of  the  bronchial  membrane  has 
been  set  up,  and  has  resulted  in  the  muco-purulent  secre- 
tion of  bronchitis.  According  to  Peacock,  as  quoted  by 
Hughes  Bennett,  the  sputum  of  acute  pneumonia  often 
contains  fibrinous  casts  of  the  bronchial  tubes,  having  im- 
bedded in  them  pus  and  pyoid  corpuscles ;  but  my  own 
observations,  as  a  general  rule,  accord  more  closely  with 


/.M M  MIRATION  OF  SPlTTUM  IN  PHTHISIS,  ETC.      201 

those  of  Dr.  Beale,  who  states  that  the  rusty  sputum,  in 
its  early  stages,  contains  a  number  of  large  spherical  col- 
lections of  minute  oil  globules,  exudation  corpuscles,  or 
granular  cells,  together  with  a  vast  number  of  minute 
granular  corpuscles  of  a  circular  form,  which  are  developed 
in  the  exudation  poured  out  in  the  air-cells  of  the  lung, 
with  numerous  blood  globules,  for  the  most  part  separated 
from  each  other,  to  the  presence  of  which  the  peculiar 
color  of  the  sputum  is  due.  At  a  later  stage,  in  bad  cases, 
the  quantity  of  blood  increases,  the  mass  is  nearly  fluid 
(constituting  the  diffluent  prune-juice  sputum),  and  con- 
tains an  immense  number  of  disintegrated  cells,  and  much 
granular  matter,  with  numerous  altered  and  ragged  red 
blood  corpuscles. 

In  some  investigations  into  the  condition  of  pneumonic 
lung  in  the  early  stage  of  red  hepatization,  contributed 
for  a  paper  by  Dr.  J.  H.  Packard  in  the  Am.  Jour,  of 
Med.  Sciences  for  January,  1870,  I  found  that  under  a  -£% 
many  air-cells  could  be  seen,  entirely  filled  with  a  mixture 
of  Leucocytes  and  red  blood  corpuscles,  in  about  equal 
proportions,  with  some  epithelium,  and  but  little  of  the 
fibrinous  material  described  by  Prof.  Bennett ;  and  it 
occurred  to  me  that  perhaps  a  higher  magnifying  power 
might  resolve  the  masses  he  describes  into  similar  ingre- 
dients, as  maintained  by  Dr.  J.  M.  Da  Costa,  of  this  city, 
in  his  able  paper  on  the  Minute  Anatomy  of  Pneumonia, 
published  in  the  American  Jour,  of  Med.  Sci.  for  October, 
1855. 

Dr.  Walshe  (Diseases  of  the  Lungs,  Philadelphia  re- 
print, 1860,  p.  279)  asserts  that  this  frequent  replacement 
of  pus  cells  by  exudation  corpuscles,  announced  by  Dr. 
Da  Costa  as  a  novelty,  has  been  mentioned  yearly  in  his 
own  lectures  since  1847;  but,  of  course,  the  doctrines  in 
regard  to  the  identity  of  all  Leucocytes,  taught  in  this 

18 


202  MEDICAL  MICROSCOPY. 

work,  render  a  revision  of  all  such  observations  neces- 
sary. 

Microscopic  examination  of  substances  ejected  from  the 
mouth  will  often  enable  us  to  decide  where  the  red  blood 
disks  contained  in  the  sputum  have  been  effused.  For  ex- 
ample, if  the  red  disks  have  lost  their  color,  have  become 
thicker  than  normal,  or  bell-shaped  (as  imperfectly  shown  in 
Fig.  It),  and  are  associated  with  Leucocytes  having  the 
Salivary  Corpuscular  Form  (Fig.  10,  also  Chapter  VIII.), 
we  may  presume  that  the  hemorrhage  has  taken  place 
within  the  oral  cavity ;  or  should  the  red  globules  be  of 
normal  shape  and  color,  and  accompanied  by  "mucous 
corpuscles"  exhibiting,  when  examined  upon  a  slide  that 
is  slightly  warmed,  the  characteristic  amoeboid  move- 
ments, it  is  probable  they  have  been  effused,  if  the  hemor- 
rhage is  small,  in  some  part  of  the  fauces  or  trachea. 
Again,  cases  sometimes  occur  when  there  is  doubt  whether 
blood  said  to  be  vomited  is  not  rather  the  result  of  haemop- 
tysis, and  vice  versa,  a  question  which  may  occasionally 
be  decided  in  favor  of  haematemesis  by  the  discovery  of  a 
large  quantity  of  starch  granules,  muscular  fiber  (see  Fig. 
14),  or  other  articles  of  food.  Lastly,  from  an  example 
which  occurred  in  the  Pennsylvania  Hospital  several 
years  since,  while  I  was  resident  physician  to  that  institu- 
tion, I  think  we  may  sometimes  diagnosticate  pulmonary 
hemorrhage  by  the  form  of  the  clots  expectorated.  The 
case,  which,  although  I  unfortunately  have  no  notes  of  it, 
is  vividly  impressed  upon  my  memory,  was  as. follows: 
A  middle-aged  colored  man,  by  occupation  a  carter,  was 
admitted  as  a  recent  accident,  having  fallen  from  his  cart 
in  front  of  the  wheel,  which  passed  over  his  body  diago- 
nally, crossing  the  lower  part  of  the  thorax  on  the  right 
side;  and  the  upper  part  of  the  abdomen  on  the  left. 
When  brought  in,  he  was  suffering  from  severe  depression 
of  the  vital  powers,  whence  he  never  reacted,  but  died  in 


EXAMINATION  OF  SPUTUM  IN  PHTHISIS,  ETC.     203 

about  thirty-six  hours,  evidently  from  shock,  and  loss  of 
blood,  which,  while  his  strength  lasted,  he  expectorated 
freely.  I  examined  a  number  of  specimens  of  this  sputum, 
and  found  that  all  showed  numerous  rounded  coagula,  vary- 
ing from  semi-oval  to  oval,  in  the  latter  case  closely  resem- 
bling in  shape  and  size  the  pulmonary  vesicles,  of  which 
they  seemed  to  be  casts.  At  the  autopsy,  the  liver  was 
found  to  be  ruptured,  the  cavity  of  the  peritoneum  con- 
tained a  large  amount  of  blood,  and  the  lower  lobe  of 
the  right  lung  was  bruised  slightly,  torn,  and  nearly  filled 
up  with  dark,  moderately  firm  clots ;  specimens  of  bloody 
mucus  taken  from  the  larger  branches  of  the  right 
bronchus  showed  coagula  of  similar  shape  and  size  to 
those  found  before  death  in  the  expectoration.  I  have 
long  hoped  to  be  able  to  corroborate  this  observation  in 
other  analogous  cases ;  but,  no  opportunity  having  oc- 
curred, I  now  give  it  for  what  it  is  worth. 

The  detection  of  malingerers  is  one  of  the  crowning 
triumphs  of  microscopic  diagnosis,  as  in  the  following  case 
related  by  Prof.  Hughes  Bennett,  which  teaches  us  how 
important  is  such  examination,  even  where  observation 
with  the  naked  eye  seems  amply  sufficient  to  determine 
the  disease.  Dr.  Bennett  states,  "  Some  years  ago  I  was 
summoned  to  see  a  dispensary  patient  laboring  under 
bronchitis,  who  was  spitting  florid  blood;  and,  examining 
the  sputum  with  a  microscope,  I  found  that  the  colored 
blood  corpuscles  were  those  of  a  bird.  On  my  telling  her 
she  had  mixed  a  bird's  blood  with  the  expectoration,  her 
astonishment  was  unbounded,  and  she  confessed  that  she 
had  done  so  for  the  purpose  of  imposition." 

According  to  Yon  Du'ben,  portions  of  tissue  strongly 
resembling  fragments  of  mucous  membrane  sometimes 
detach  themselves  and  become  mixed  with  the  sputum 
ferruginosum  of  pneumonia.  He  states  that  they  differ 
from  casts  of  the  bronchial  tubes,  above  referred  to,  in 


204  '    MEDICAL  MICROSCOPY. 

presenting  none  of  the  granules  which  occur  in  the  latter, 
and  in  being  more  irregular  and  flattened  in  form  ;  he  also 
describes,  as  a  quite  constant  ingredient  of  pneumonic 
sputa,  red  flakes,  minutely  granulated,  of  variable  and 
indefinite  shape,  consisting  apparently  of  haematine,  and 
remarks  that  "  in  either  bronchitis  or  pneumonia  the 
physical  signs  are  pretty  reliable  clinical  guides ;  but  in 
lobular  and  occult  pneumonia  the  microscope  is  indispen- 
sable for  early  and  correct  diagnosis." 

It  is  now  nearly  twenty  years  since  it  was  first  estab- 
lished by  Schroder  van  der  Kolk  and  Dr.  Andrew  Clark, 
that  small  fragments  of  elastic  fiber  from  the  walls  of  the 
pulmonary  vesicles  may  sometimes  be  detected  by  the 
microscope  in  the  expectoration  of  persons  suffering  from 
phthisis.  Prof.  Beale  recommends  that  several  specimens 
should  be  cut  off  from  the  sputum,  any  "  little  grayish 
masses"  being  particularly  selected,  treated  with  acetic 
acid,  and  carefully  examined ;  but  to  Dr.  Samuel  Fenwick, 
Assistant  Physician  to  the  London  Hospital,  we  owe  the 
important  suggestion  of  first  liquefying  the  sputum  by 
boiling  it  with  caustic  soda,  in  which  process  we  disinte- 
grate most  of  the  cell-elements,  which  obscure  the  view 
under  the  microscope,  and  then,  on  allowing  the  fluid  to 
stand  undisturbed  in  a  conical  vessel,  all  the  elastic  tissue, 
upon  which  diagnosis  mainly  depends,  sinks  to  the  bottom, 
and  may  readily  be  detected  by  the  examination  of  a  very 
few  slides,  instead  of  requiring  for  its  discovery  the  tedious 
research  for  hours  which  was  formerly  necessary. 

So  important  is  the  subject  of  early  diagnosis  in  that 
wide-spread  and  much-dreaded  disease,  consumption,  that 
I  propose  to  quote  at  some  length  the  very  valuable  paper 
of  Dr.  Fenwick  in  the  London  Lancet  for  Dec.  5  and  12, 
1868,  illustrating  and  combining  it  with  my  own  observa- 
tion in  the  wards  of  the  Pennsylvania  Hospital. 

In  attempting  to  test  the  sputum  of  a  supposed  case  of 


EXAMINATION   OF  SPUTUM  IN  PHTHISIS,  ETC.     205 

phthisis  by  this  method,  I  have  found  it  advisable  to  direct 
the  patient  to  expectorate  for  twenty-four  hours  into  a 
clean  porcelain  cup,  taking  great  care  to  avoid  depositing 
anything  but  what  he  coughs  up  in  the  vessel,  and  to  pre- 
vent any  other  person  from  spitting  into  it ;  also  to  chew 
no  tobacco,  and  to  rinse  out  the  mouth  thoroughly  after 
eating,  during  that  day.  If  only  a  smaller  quantity  of 
expectoration  can  be  obtained,  it  is  advisable  to  examine 
that  ejected  on  getting  up  in  the  morning.  About  a  fluid- 
ounce  of  the  dense  viscid  sputum  should  then  be  poured 
into  a  Beaker  glass  (I  have  found  a  small  evaporating- 
dish  answer  equally  well,  and  it  is  much  less  likely  to  be 
broken),  an  equal  bulk  of  the  solution  of  caustic  soda 
added,  the  vessel  placed  upon  one  of  the  rings  of  a  retort- 
stand  (or  supported  by  a  stout  wire  ring  held  in  the  hand), 
the  flame  of  an  alcohol  lamp  applied  beneath,  and  the 
mixture  gradually  raised  to  the  boiling  temperature,  stir- 
ring it  constantly  in  the  mean  while  with  a  glass  rod.  Dr. 
Fenwick  remarks  that  generally  the  expectoration  requires 
an  equal  quantity  of  the  soda  solution  to  dissolve  it ;  but 
if  the  mucus  is  unusually  tenacious  more  will  be  necessary. 
This  I  have  rarely  found  to  be  the  case ;  but  if  requisite, 
that  is,  should  the  compound  fail  to  become  entirely  fluid 
as  soon  as  the  boiling  alkaline  solution  has  fairly  acted 
upon  the  tough  masses,  divided  and  spread  out  for  the  pur- 
pose by  the  rod,  the  dish  may  be  removed  from  the  flame, 
one-third  or  one-half  more  liquor  soda  slowly  stirred  in, 
and  the  boiling  continued  as  before.  Dr.  Fenwick  recom- 
mends that,  as  soon  as  liquefied,  it  should  be  immediately 
poured  into  a  conical  glass,  and  three  or  four  times  its 
bulk  of  cold  distilled  water  should  be  added,  so  that  the 
fragments  of  elastic  tissue  "  may  be  at  once  carried  to  the 
bottom  ;"  but,  as  few  of  the  glass  vessels  we  obtain  are  suffi- 
ciently annealed  to  bear  the  sudden  infusion  of  a  boiling 
liquid,  it  is  much  safer  to  partly  fill  the  conical  vessel  with 

18* 


206  MEDICAL  MICROSCOPY. 

clean  water  slightly  warmed  first,  and  then,  stirring  in  the 
hot  solution,  avoid  all  risk  of  fracture.  As  a  general  rule,  the 
glass  and  contained  fluid  should  now  be  carefully  covered 
and  set  aside  for  two  or  three  hours ;  for  although  Dr. 
Fen  wick  states  that  he  has  frequently  detected  the  elastic 
fiber  in  from  six  to  ten  minutes,  he  considers  it  advisable 
to  allow  a  longer  time  for  deposition  to  take  place,  at  least 
when  there  is  reason  to  suspect  only  a  small  quantity  of 
the  sought-for  material ;  at  the  end  of  this  time  a  tube- 
pipette  should  be  dipped  to  the  bottom  of  the  conical  glass, 
and  whatever  deposit  there  exists  removed  (as  directed 
in  Chapter  III.,  p.  68),  a  drop  let  fall  upon  a  glass  slide, 
a  cover  applied,  and  the  whole  transferred  to  the  stage  of 
the  microscope.  Our  author  judiciously  remarks,  "  Great 
care  should  be  taken  that  the  dipping-tube  is  perfectly 
clean.  In  one  of  my  earlier  experiments  I  found  elastic 
fiber  in  the  expectoration  of  a  case  of  recent  bronchitis. 
I  had  shortly  before  used  the  same  tube  in  the  examina- 
tion of  some  sputa  sent  by  a  person  suffering  from  phthisis, 
and  with  a  new  tube  I  could  find  no  further  trace  of  lung- 
structure.  There  is  no  difficulty  in  examining  the  elastic 
fiber  on  a  common  slide,  but  it  is  always  advisable  to  use 
cells ;  these  are  best  made  of  vulcanite  fixed  with  cement. 
The  alkaline  solution  acts  rapidly  on  the  marine  glue 
generally  used  to  attach  cells.  The  higher  powers  of  the 
microscope  are  never  required  in  this  method  of  examina- 
tion. I  generally  use  a  strong  eye-piece,  and  have  an  inch 
and  a  half  and  a  half-inch  object-glass  fixed  to  the  instru- 
ment by  a  'double  arm.'" 

In  regard  to  the  cells  thus  recommended,  their  chief 
object  appears  to  be  the  enabling  an  observer  to  examine 
a  larger  quantity  of  deposit  upon  a  single  slide,  and  this 
end  may  be  served  by  using  one  of  the  slides  with  con- 
cave centers,  furnished  by  the  instrument-makers  at  $2.00 
per  dozen,  although  I  have  almost  always  employed 


EXAMINATION  OF  SPUTUM  IN  PHTHISIS,  ETC.      207 

the  ordinary  glass  slip  with  satisfaction.  The  magnifying 
power  suggested  by  Dr.  F.  is  that  of  about  150  diameters, 
while  my  researches  have  been  made  with  a  £  inch  ob- 
jective and  the  lowest -eye-piece,  affording  an  amplifying 
power  slightly  exceeding  200  diameters,  my  own  experience 
disposing  me  strongly  in  favor  of  using  more  powerful 
objectives  and  shallower  eye-pieces,  instead  of  the  reverse. 
The  "  double  arm"  or  nose-piece  referred  to  is  a  contrivance 
for  instantly  exchanging  one  objective  for  another,  on  the 
same  principle  as  that  employed  in  the  diaphragm  plate  of 
the  microscope  for  substituting  different-sized  apertures. 
Dr.  Fenwick  continues:  "The  amount  of  lung-tissue  varies 
greatly  in  different  cases.  In  one  I  counted  as  many  as 
eight  hundred  fragments  in  mucus  that  had  been  coughed 
up  in  twelve  hours;  and  we  frequently  find  from  fifty  to 
sixty  pieces,  when  from  auscultation  we  should  have  ex- 
pected the  destruction  to  be  only  slight."  And  again: 
"  The  larger  bronchial  tubes  undergoing  disintegration  are 
occasionally  represented  by  a  simple  layer  of  membrane  ; 
but  the  smaller  tubes  yield  portions  of  considerable  length, 
exhibiting  their  branching  arrangement.  In  the  majority 
of  cases  we  meet  with  all  these  different  forms  of  lung- 
structure  in  a  single  specimen  of  expectoration,  and  we 
may  estimate  the  rate  at  which  the  disease  is  progressing 
by  counting  the  particles."  According  to  Dr.  Fenwick, 
"recognition  of  the  various  tissue  elements  is  a  simple 
matter,"  and  I  have  no  doubt,  to  his  experienced  eye,  such 
is  eminently  the  fact;  yet  it  seems  to  me  that,  among  us  at 
least,  it  will  often  happen  that  the  microscopist  unaccus- 
tomed to  the  observation  of  fragments  of  lung-tissue  will 
find  at  first  some  difficulty  in  recognizing  the  structure,  and 
I  would  advise  any  one  undertaking  this  branch  of  research 
to  familiarize  himself  with  the  appearance  of  the  bundles  of 
anastomosing  fibers  which  form  the  walls  of  the  air-cells,  by 
teasing  out  a  thin  section  of  pulmonary  tissue,  boiling  it  with 


208  MEDICAL  MICROSCOPY 

caustic  soda,  and  examining  it  as  above  directed.    The  gen- 
eral aspect  of  elastic  tissue  of  the  lung  is  exhibited  in  Pig. 

FIG.  19.   , 


FRAGMENTS  OF  LUNG-TISSUE  IN  SPUTUM  BOILED  WITH  CAUSTIC  SODA. 
X  220  Diameters. 


19,  whence  an  idea  of  the  apparent  magnitude  of  the  pul- 
monary air  vesicles  may  be  obtained.  It  must  not  be  for- 
gotten, however,  that  in  cases  complicated  or  preceded  by 
emphysema  (although  such  are  very  rare),  the  air-cells 
being  enlarged,  some  of  the  elastic  fiber  would  present  a 
correspondingly  altered  appearance.  Among  the  most 
common  extraneous  matters  occurring  in  sputum  are  frag- 
ments of  flax  or  cotton,  which,  when  frayed  out  and  curled 
up,  as  they  sometimes  are,  very  closely  imitate  portions 
of  individual  vesicles  in  appearance ;  nor  is  the  Y-shaped 
form  (Fi'g.  20),  upon  which  stress  is  laid  by  some,  quite 
characteristic,  since  this  may  happen  to  be  simulated 


EXAMINATION  OF  SPUTUM  IN  PHTHISIS,  ETC.     209 

by  a  couple  of  fibers  which  have  been  split  apart  for 
a  portion  of  their  length,  the  other  extremities  still  re- 
maining attached.  By  accident  only,  however,  could  such 
materials  exhibit  the  arrangement  of  fibers  shown  by  the 
smallest  fragment  delineated  in  Fig.  19,  which  seems  to  be 
from  the  junction  of  the  walls  of  three  air  vesicles,  and  I 
should  consider  the  detection  of  two  or  three  such  particles 
absolutely  pathognomonic  of  ulceration  in  the  lung.  Por- 
tions of  true  elastic  tissue  from  meat  employed  as  food 
may  sometimes,  in  spite  of  all  our  precautions,  show  them- 
selves in  the  sputum  and  complicate  the  diagnosis.  As 
shown  by  Dr.  Fenwick,  the  fibers  from  the  fascia  of  a 
beefsteak  are  much  larger  and  coarser  in  appearance,  while 
those  from  the  peritoneum,  as,  for  instance,  the  "  skin"  of 
a  sausage,  although  more  delicate,  differ  in  their  entire 
want  of  any  cellular  arrangement.  Indeed,  I  have  found 
this  suggestive  outline  (for  it  is  often  nothing  more  than  a 
hint)  of  the  shape  and  size  of  the  pulmonary  air  vesicles, 
when  strengthened  by  recurrence  in  several  different  in- 
stances, the  most  satisfactory  evidence  that  suspected 
fragments  were  in  reality  tissue  from  the  parenchyma  of 
the  lung.  Another  fibrous  material  which  might  sometimes 
lead  to  fallacious  conclusions  is  the  Leptotbrix  buccalis, 
whose  filaments  sometimes  grow  so  luxuriantly  in  the 
tartar  of  the  teeth ;  as,  however,  they  are  more  slender 
than  the  fibers  of  elastic  tissue  (Fig.  20),  not  flexible 
enough  to  curl  so  readily,  and  rarely,  I  believe,  dichoto- 
mous,  it  is  only  necessary  to  be  on  one's  guard  to  avoid 
error.  Dr.  Fenwick  figures  a  portion  of  vegetable  structure 
which,  as  he  says,  could  only  be  mistaken  by  a  very  super- 
ficial observer ;  but  some  other  vegetable  tissues  approx- 
imate much  more  closely  to  elastic  fiber  in  appearance  (Fig. 
20).  Not  long  since  I  had  brought  me,  by  an  attending 
physician  of  one  of  our  city  hospitals,  some  boiled  sputum 
in  which  existed  what  he  suspected  were  fragments  of 


210  MEDICAL  MICROSCOPY. 

pulmonary  air  vesicles,  and  which  certainly  bore  to  the 
latter  a  very  strong  resemblance,  but  proved,  on  strict 
scrutiny,  to  be  some  minute  particles  of  tobacco-leaf. 

After  much  careful  investigation  of  various  specimens 
of  sputum  from  both  hospital  patients  and  cases  in  private 
practice,  for  the  purpose  of  detecting  some  characteristics  of 
the  lung-tissue  by  which  it  could  be  promptly  and  certainly 
recognized,  it  occurred  to  me  that  the  fibers  of  the  air 
vesicles,  being  elastic,  must  break,  like  a  thread  of  india- 
rubber,  with  a  square  transverse  fracture,  while  the  fila- 
ments of  any  inelastic  material,  whether  vegetable  or 
animal,  would  fray  out,  as  it  were,  and  present  to  the  eye 
a  more  or  less  obscurely  pointed  appearance.  Further 
observation  proved  my  hypothesis  to  be  correct  in  numer- 
ous instances,  and  I  believe  that  this  characteristic  of  ab- 
ruptly broken  fibers  will  be  found  one  of  the  most  useful 
means  yet  suggested  for  the  recognition  of  pulmonary 
tissue  in  sputum. 

It  must  not  be  forgotten  that  these  portions  of  elastic 
tissue  from  the  lung  are  only  to  be  found  in  the  sputum 
while  breaking  down  of  the  parenchyma  is  in  progress  ;  for 
example,  Dr.  Fenwick  remarks  that  he  examined  after 
death  the  contents  of  a  cavity  which  occupied  the  whole 
upper  lobe  of  the  lung,  the  walls  of  which  consisted  of  a 
thin  layer  of  lung  interposed  between  a  cap  of  thickened 
pleura  and  a  dense  membrane  lining  the  cavity.  The 
mucus  in  it  showed  no  trace  of  lung-tissue.  In  regard  to 
the  varieties  of  quantity,  size  of  particles,  etc.,  he  observes, 
"The  size  of  the  fragments  of  lung  varies  greatly,  but  as 
a  general  rule  the  finer  the  crepitation  the  more  the  smaller 
pieces  abound."  "Wherever  I  have  found  a  marked  differ- 
ence in  the  amount  of  lung  expectorated  at  different  times, 
I  have  found  the  case  eventually  to  assume  a  very  chronic 
form,  notwithstanding  a  rapid  destruction  may  have  taken 
place  at  the  commencement  of  the  disease.  A  man,  forty- 


EXAMINATION  OF  SPUTUM  IN  FI1TJ//SM,   KTC.     211 

five  years  of  age,  was  admitted  under  my  care  at  the  Vic- 
toria Park  Hospital  in  December,  1865.     He  stated  that 

FIG.  20. 


ACCIDENTAL  INGREDIENTS  OF  BOILED  SPUTUM  RESEMBLING  P.ULMOXARY  ELASTIC  FIBER. 
X  220  Diameters. 

Cell-walls    of  starch  granules,  filaments  of  Leptothrix,  fragments  of  vegetable 
tissues,  and  split  fibers  of  flax  from  some  muslin  fabric,  "  frayed  out"  at  the  ends. 


he  had  been  only  three  weeks  out  of  health.  He  had 
great  thirst  and  a  dry  tongue,  pulse  108,  dullness  on  per- 
cussion, and  mucous  rales  below  the  right  clavicle.  He 
lost  six  pounds  in  weight  during  the  next  six  weeks,  and 
auscultation  afforded  evidence  of  a  cavity.  In  April,  when 
he  had  somewhat  improved,  I  found  108  fragments  of 
lung  in  the  sputa  of  twelve  hours.  In  May  the  sputa 
still  contained  lung ;  but  in  July  I  could  detect  none,  and 


212  MEDICAL  MICROSCOPY. 

by  the  end  of  that  month  I  could  still  only  find  a  few 
filaments.  His  general  health  began  now  to  improve,  and 
he  remained  so  well  for  the  next  two  years  that  he  only 
lost  two  pounds  in  weight.  When  I  last  saw  him  he 
complained  chiefly  of  dyspnoea;  but  I  heard  lately  that  he 
had  died  very  suddenly.  As  a  general  rule,  the  increased 
ulceration  of  lung  is  accompanied  by  increased  fever  and 
emaciation,  as  though  the  destruction  of  tissue  was  a 
result  of  pneumonia  attacking  the  diseased  part ;  but  in 
other  cases  I  have  found  the  increased  destruction  to  pre- 
cede the  augmented  constitutional  disturbance.  In  some 
the  fever  is  connected  only  with  bronchitis,  and,  although 
the  amount  of  expectoration  is  very  great,  the  quantity  of 
lung-structures  contained  in  it  remains  the  same.  Cases 
of  this  latter  kind  are  more  hopeful  than  of  the  former.  I 
believe  the  microscope  affords  at  present  the  only  means 
of  distinguishing  between  them.  There  is  a  growing 
conviction  among  pathologists  that  physicians  include 
under  the  name  of  phthisis  different  affections,  agreeing 
only  in  their  tendency  to  produce  ulceration  of  the  lung. 
We  cannot  distinguish  these  affections  from  each  other  by 
auscultation,  but  we  can  reasonably  hope  that  the  exami- 
nation of  the  sputa  may  throw  some  light  upon  this  sub- 
ject. Generally  the  pulmonary  elastic  fiber  presents  under 
the  microscope  a  clear  and  well-defined  edge.  But  in 
some  cases  it  has  a  dull  and  very  granular  appearance, 
showing  that  the  elastic  tissue  has  itself  undergone  a 
change.  The  number  of  cases  presenting  this  peculiarity 
is  small;  I  should  say  not  ten  per  cent.  I  have  notes  of 
nine  cases  in  which  it  was  present,  and  in  all  the  disease 
was  chronic.  One  had  suffered  from  cough  for  eleven 
years,  originating  in  whooping-cough  ;  one  had  had  chest 
symptoms  for  nine  years,  one  for  eight,  one  for  seven,  two 
for  six,  and  two  for  three  years.  Six  of  these  were  males, 
and  three  females ;  with  two  exceptions,  all  were  between 


OF  SPUTUM  IN  PHTHISIS,  ETC.     213 

thirty  and  fifty  years  of  age.  Seven  had  haemoptysis;  in 
one  no  haemoptysis  had  occurred ;  the  history  of  the  other 
is  imperfect  on  this  point.  The  destruction  of  lung  was 
very  slowly  going  on  in  all  but  one  case.  We  might  sup- 
pose that  in  this  class  the  tubercle  is  a  secondary  affection; 
but  generally  haemoptysis  is  the  first  symptom.  I  am 
inclined,  from  the  history  and  the  slow  progress  of  these 
cases,  to  believe  that  a  long  interval  has  elapsed  between 
the  formation  and  the  elimination  of  the  tubercle,  during 
which  the  presence  of  the  morbid  product  has  altered  the 
normal  condition  of  the  surrounding  structures.  In  others 
I  have  found  the  fibers  surrounding  the  cells  greatly  in- 
creased in  number,  and,  instead  of  appearing  parallel  to 
each  other,  they  have  formed  a  matted,  confused  layer. 
This  I  have  only  met  with  in  very  chronic  cases,  and  I 
suspect  that  it  indicates  a  form  of  disease  in  which  the 
original  morbid  change  affects  especially  the  fibrous  struc- 
ture of  the  system." 

In  regard  to  the  actual  practical  value  of  the  appearance 
of  lung-tissue  in  the  sputum  we  have  the  direct  testimony 
of  Dr.  Beale  and  Dr.  Bennett,  than  whom  it  is  probable 
no  higher  authorities  exist.  Dr.  Beale  remarks,  on  p. 
186  of  The  Microscope  in  Practical  Medicine:  "Dr.  Ben- 
nett mentions  a  case  in  which  this  elastic  tissue  was  met 
with  at  a  time  when  no  other  signs  of  phthisis  wrere 
present.  The  sputum  was  examined  by  Dr.  Bennett,  Dr. 
II iff,  Prof.  Quekett,  Mr.  Rainey,  and  myself.  All  con- 
curred in  pronouncing  the  substance  to  be  pulmonary  tissue. 
After  a  time  other  symptoms  of  the  affection  manifested 
themselves,  the  physical  signs  of  a  cavity  became  distinct, 
and  the  patient  died."  Again,  the  same  indefatigable 
observer  states  in  regard  to  a  specimen  where  fragments  of 
lung-tissue  were  found  in  very  large  quantity :  "  The 
amount  of  expectoration  was  very  small,  not  amounting  to 
more  than  half  a  dozen  pellets  in  twenty-four  hours.  The 

19 


214  MEDICAL  MICROSCOPY. 

case  was  that  of  a  stout  lady,  of  about  fifty  years  of  age, 
who  had  been  suffering  from  cough  for  about  six  weeks, 
consequent  upon  taking  cold.  There  was  slight  dullness 
under  one  clavicle,  but  no  marked  symptoms  of  phthisis; 
in  fact,  it  was  difficult  to  persuade  the  patient  that  there 
was  anything  the  matter  with  her,  and  the  diagnosis  rested 
almost  entirely  on  the  fact  of  the  presence  of  the  pulmo- 
nary elastic  tissue  in  the  pellet  of  sputum  which  was  sub- 
jected to  examination."  Seeing,  then,  that  the  diagnostic 
value  of  lung-tissue  in  sputum  has  been  for  many  years 
fully  established,  by  the  labors  of  such  microscopists  as 
Yan  der  Kolk,  Bennett,  and  Beale,  it  -seems  to  me  that  the 
statement  of  Dr.  Fenwick  in  regard  to  the  results  obtained 
by  his  very  ingenious  method  (which  only  claims  to  be  a 
plan  for  generally  utilizing  the  knowledge  we  previously 
possessed,  viz.,  that  elastic  fibers  did  exist  in  the  sputa 
from  ulcerating  lungs)  may  be  at  once  accepted  as  a  most 
important  contribution  to  our  information  concerning  Con- 
sumption, and  calculated  to  afford  invaluable  aid  in  detect- 
ing this  terrible  disease  at  that  early  stage  of  its  course 
when  it  is  alone  (or  chiefly)  amenable  to  treatment. 
Among  the  cases  of  pulmonary  disease  in  the  Pennsyl- 
vania Hospital  when  examination  of  the  sputum  according 
to  this  formula  was  practiced,  one  of  the  most  remarkable 
was  as  follows  ; — 

H.  S.,  a  laborer,  aged  23,  was  admitted  into  the  institu- 
tion on  the  28th  of  September,  1869,  for  Pleuro-pneumonia, 
which,  although  the  disease  yielded  somewhat  to  treatment 
and  the  physical  signs  improved  for  a  time,  was  not  fol- 
lowed by  convalescence.  Frequent  examinations  of  this 
patient's  sputa  were  made,  uniformly  without  the  detection 
of  any  elastic  tissue,  however,  until  a  few  weeks  before 
his  death,  when  I  discovered  a  single  specimen  of  the  cell- 
wall  of  three  pulmonary  air  vesicles,  which,  as  there  was 
no  evidence  of  tubercular  deposit  at  either  apex,  caused 


EXAMINATION  OF  SPUTUM  IN  PHTHISIS,  ETC.     215 

some  doubt  to  arise  in  regard  to  the  value  of  this  method 
as  a  means  of  diagnosis  in  pulmonary  disease.  On  the 
10th  of  December,  however,  the  patient  died,  and  at  the 
post-mortem  the  pulmonary  organs  Were  found  apparently 
free  from  tubercle;  but  near  the  base  of  the  right  lung  a 
small  abscess,  not  larger  than  a  hazel-nut,  was  detected, 
which  no  doubt  furnished  the  fragment  of  elastic  tissue 
that  had  appeared  beneath  my  microscope.  The  liver  was 
found  riddled  with  abscesses,  some  of  them  very  large, 
and  probably  the  immediate  cause  of  the  fatal  result.  (See 
also  case  appended  to  this  chapter.) 

The  statistics  supplied  by  Dr.  Fen  wick  comprise  an 
analysis  of  141  cases.  Of  these  he  remarks:  "In  all  I 
have  recorded  in  my  notes  the  history,  general  symptoms, 
physical  examination  of  the  chest,  and  the  microscopical 
examination  of  the  sputa.  As  the  cases  are  taken  with- 
out selection,  they  fairly  show  what  amount  of  assistance 
the  physician  may  expect  to  derive  from  this  method  of 
diagnosis.  There  are  no  cases  of  phthisis  more  difficult 
of  diagnosis  than  those  in  which  that  disease  is  associated 
with  inflammatory  affections  of  the  air-passages.  In  such 
the  microscopical  examination  of  the  sputa  has  often  proved 
of  the  greatest  value,  and  in  a  few  minutes  has  decided 
the  diagnosis.  I  have  notes  of  twenty-three  cases  of  bron- 
chitis in  which  phthisis  was  suspected,  either  from  the 
general  symptoms  or  from  the  examination  of  the  chest. 
^n  eleven,  lung-tissue  was  found  in  the  sputa;  three  of 
these  ceased  to  attend  the  hospital  shortly  after  the  date 
of  the  examination,  but  the  subsequent  history  of  the  re- 
mainder proved  that  consumption  was  present.  Of  the 
twelve  in  which  pulmonary  elastic  fiber  was  not  found,  six 
shortly  ceased  to  attend,  and  the  remaining  six  proved  to 
be  cases  of  uncomplicated  bronchitis.  As  far,  therefore, 
as  can  be  ascertained,  although  the  general  symptoms  and 
the  examination  of  the  chest  gave  uncertain  results,  the 


216  MEDICAL  MICROSCOPY. 

microscope  has  distinctly  indicated  the  nature  of  the  dis- 
ease in  all. 

"  When  phthisis  occurs  in  persons  who  have  for  many 
years  suffered  from  chronic  catarrh,  the  diagnosis  is  often 
very  difficult.  The  resonance  on  percussion  may  be  ab- 
normally clear,  from  the  existence  of  emphysema,  and 
auscultation  frequently  fails  to  reveal  positive  signs  of  the 
presence  of  tubercle.  The  following  case  is  an  example 
of  this  form  of  the  disease,  and  shows  the  value  of  micro- 
scopical examination  of  the  sputa.  A  man,  thirty-six  years 
of  age,  had  been  subject  to  cough  for  six  years,  and  had 
suffered  from  hemoptysis  two  years  before  his  admission 
as  an  out-patient  at  the  Victoria  Park  Hospital.  There 
was  no  dullness  on  percussion,  dry  rhonchus  could  be  heard 
over  the  whole  of  the  anterior  part  of  the  chest,  and  moist 
rales  were  present  at  the  base  of  the  lungs.  The  expecto- 
ration in  twelve  hours  amounted  to  seven  drachms  of 
thin  watery  fluid ;  but,  when  examined  microscopically, 
a  considerable  amount  of  pulmonary  elastic  fiber  was 
found. 

"  It  is  often  difficult  to  diagnose  phthisis  at  an  early  stage, 
when  along  with  the  physical  signs  of  bronchitis  the  larynx 
is  diseased.  The  indications  presented  by  the  vocal  fremitus 
are  not  to  be  obtained  ;  and  if  there  be  no  distinct  dullness 
on  percussion,  one  is  left  in  doubt  as  to  the  nature  of  the 
case.  The  difficulty  is  still  further  increased  if  the  occu- 
pation of  the  patient  has  exposed  him  to  the  action  of  dust 
or  to  the  prolonged  use  of  the  voice.  An  omnibus-con- 
ductor, thirty-seven  years  of  age,  came  under  my  care  in 
July,  1866.  He  had  loss  of  voice,  with  cough,  and  a 
little  expectoration,  for  two  months.  Pulse  84.  I  fancied 
that  I  could  detect  a  slight  diminution  in  the  percussion- 
note  below  the  right  clavicle,  but  of  this  I  could  not  satisfy 
myself.  The  only  sign  on  auscultation  was  a  dry  rhouchus, 
diffused  on  both  sides  of  the  chest.  He  brought  to  me  the 


EXAMINATION  OF  SPUTUM  IN  PHTHISIS,  ETC.     217 

expectoration  of  three  mornings,  which  only  amounted  to 
seven  drachms  of  thin  mucus.  The  microscope  showed 
forty-one  pieces  of  lung-tissue  in  it.  Hemoptysis  occurred 
two  weeks  afterwards,  and  his  pulse  rose  to  96.  In 
December,  1866,  he  had  lost  in  weight  seven  pounds,  and 
the  dullness  below  the  clavicle  was  distinct.  He  remained 
under  observation  until  the  following  May,  but  was  greatly 
emaciated  when  I  last  saw  him. 

"  Phthisis  is  often  ushered  in  with  an  attack  of  pleurisy. 
In  such  cases  the  development  of  the  signs  of  consumption 
is  frequently  very  gradual,  and  it  is  only  by  careful  attention 
to  the  history  of  the  patient  that  a  correct  conclusion  can  be 
arrived  at.  I  have  notes  of  some  cases  of  pleurisy  in  which 
the  slowness  of  convalescence  led  to  the  suspicion  of 
tubercle,  but  no  lung-tissue  could  be  found  in  the  sputa ; 
in  all,  the  subsequent  histories  proved  the  disease  to  have 
been  of  a  simply  inflammatory  nature.  The  following 
case,  however,  will  show  in  a  positive  manner  how 
valuable  the  microscope  may  be  in  the  detection  of  ulcera- 
tion  of  the  lung.  A  man,  aged  thirty-three  years,  had 
been  subject  to  cough  for  fifteen  years,  and  for  six  weeks 
had  suffered  from  pleurisy.  The  microscope  detected 
twenty-seven  particles  of  pulmonary  tissue  in  the  sputa. 
The  effusion  slowly  disappeared.  Four  months  afterwards, 
mucous  rales  were  detected  below  the  left  clavicle.  He 
remained  under  observation  thirteen  months,  and  during 
the  latter  part  of  that  time  presented  all  the  ordinary 
symptoms  of  phthisis. 

"  I  have  never  detected  any  pulmonary  structure  in  the 
sputa  of  persons  affected  with  uncomplicated  pneumonia, 
although  we  might  imagine  that  minute  portions  of  lung 
might  be  thrown  off  in  this  disease.  In  the  following  case 
the  microscope  enabled  me  to  predict  the  approach  of  con- 
sumption before  any  evidence  of  the  presence  of  tubercle 
could  be  obtained  by  auscultation.  A  lady  had  been  suf- 

19* 


218  MEDICAL  MICROSCOPY. 

fering  from  pneumonia  of  the  left  lung  for  three  weeks 
before  I  saw  her.  She  had  been  losing  flesh  and  strength, 
but  had  no  cough  before  the  attack.  Neither  of  the  medical 
gentlemen  in  charge  of  the  case  nor  myself  could  detect 
any  evidence  of  tubercular  deposit  in  the  opposite  lung. 
The  expectoration  was  profuse,  but  no  lung-tissue-could 
be  discovered  in  it.  Three  weeks  afterwards,  hearing  that 
she  was  recovering  very  slowly,  I  requested  that  another 
specimen  of  her  sputa  might  be  sent  to  me,  and  in  this 
numerous  particles  of  pulmonary  elastic  fiber  were  found. 
Some  time  afterwards,  physical  signs  of  consolidation  were 
detected  at  the  apex  of  the  right  lung ;  and  she  died  of 
phthisis  eighteen  months  after  the  commencement  of  her 
illness.  This  case  shows  that  we  ought  not  to  trust  to  a 
single  examination  of  the  sputa,  when  the  results  are  of  a 
negative  character,  but  should  repeat  it  from  time  to  time 
if  the  symptoms  be  of  a  nature  to  cause  a  suspicion  of 
phthisis." 

"  I  have  noted  27  cases  in  which,  along  with  cough 
and  expectoration,  there  were  some  or  other  physical  signs 
of  consolidation  in  the  upper  lobes  of  the  lungs, — namely, 
a  difference  in  the  resonance  on  percussion  between  the 
two  sides  of  the  chest,  accompanied  by  feebleness  of  in- 
spiration, interrupted  inspiration,  increased  expiration, 
tubular  respiration,  dry  rhonchus,  occasional  mucous  click, 
or  increased  vocal  resonance.  Most  of  the  cases  were 
repeatedly  examined  with  the  stethoscope  ;  but  with  respect 
to  many  of  them  I  was  unable  to  satisfy  my  mind  as  to 
whether  or  not  tubercle  was  present.  The  expectoration 
of  each  was  examined  only  once,  and  particles  of  lung- 
tissue  were  discovered  in  21  cases.  Of  the  6  in  which 
the  microscope  failed  to  find  elastic  fiber,  2  shortly  after 
ceased  to  attend  at  the  hospital,  2  completely  lost  the 
chest  symptoms  of  which  they  had  complained,  1  after- 
wards proved  to  be  a  case  of  bronchitis,  and  the  remaining 


EXAMINATION  OF  SPUTUM  IN  PHTHISIS,  ETC.     219 

one  was  still  of  a  doubtful  nature  when  I  last  saw  it. 
When  I  commenced  to  use  the  microscope  for  the  detection 
of  phthisis,  I  was  much  surprised  at  the  frequency  of  these 
cases  in  which  pulmonary  structures  could  be  found  in 
the  sputa,  when,  according  to  the  opinion  of  auscultators, 
the  tubercle  was  in  a  crude  condition.  I  suspect  that  in 
many  of  these  cases  ulceration  is  proceeding  in  the  deeper 
portions  of  the  lung,  whilst  the  sounds  heard  through  the 
stethoscope  only  indicate  the  conditions  of  the  parts 
nearer  to  ther  surface. 

"I  have  recorded  24  cases  in  which  there  were  well- 
marked  stethoscopic  signs  of  '  softening  of  the  tubercle'  in 
the  lungs.  In  every  case  a  single  examination  showed 
the  presence  of  lung-tissue  in  the  sputa.  All  of  these 
proved  to  be  cases  of  phthisis,  and  some  of  them  have 
been  under  observation  for  two  or  three  years.  As,  how- 
ever, there  is  seldom  any  difficulty  in  the  diagnosis  in  this 
stage  of  the  disease,  the  use  of  the  microscope  is  less 
needed.  The  stethoscope  indicated  the  existence  of  cavi- 
ties in  43  more  cases,  and  pulmonary  elastic  fiber  was  found 
in  the  sputa  of  all.  I  have  mentioned  the  occurrence  of 
fragments  of  bronchial  tubes  and  of  pulmonary  cells  when 
auscultation  afforded  less  serious  indication  only.  I  there- 
fore endeavored  to  ascertain  whether  there  was  any  varia- 
tion in  the  sizes  of  the  fragments  of  lung  in  the  sputa 
corresponding  with  different  periods  of  phthisis.  The 
sizes  of  the  particles  were  noted  in  69  cases,  and  I  found 
that  the  proportion  of  bronchial  tubes  is  smallest  when 
well-marked  dullness  along  with  mucous  rales  show  that 
the  cellular  structure  of  the  lung  is  chiefly  implicated. 
The  bronchial  tubes  are  of  greatest  size  in  the  cases  pre- 
senting the  largest  cavities." 

Dr.  Fenwick  concludes  his  very  valuable  paper  with 
the  following  judicious  remarks:  "To  the  young  practi- 
tioner it  will  often  be  a  comfort  to  confirm  by  the  eye  the 


220  MEDICAL  MICROSCOPY. 

diagnosis  formed  from  the  evidence  received  by  the  ear; 
while  cases  are  constantly  occurring  to  the  most  expe- 
rienced auscultators,  in  which  the  aid  of  the  microscope 
will  be  of  value.  The  microscope  can  never  rival  the 
stethoscope  in  its  application  to  a  variety  of  cases,  but, 
like  the  spectroscope  in  chemistry,  it  often  attains  results 
in  a  few  minutes  that  the  means  in  ordinary  use  require  a 
length  of  time  to  accomplish." 

It  might  be  supposed  that  at  least  during  the  period  of 
tubercular  softening  the  appearance  of  so-called  tubercle 
corpuscles  in  the  sputum  would  aid  us  in  the  diagnosis 
of  phthisis;  but,  as  a  general  rule,  when  they  do  occur,  we 
find  them  mixed  with  so  many  Leucocytes  (pus  and  mu- 
cous corpuscles),  and  they  have  been  so  far  disintegrated, 
as  to  be  with  great  difficulty  recognized ;  indeed,  even 
when  they  are  detected,  the  physical  signs  and  general 
symptoms  are  mostly  so  well  pronounced  that  any  assist- 
ance in  diagnosis  is  unnecessary.  For  a  definition  of  the 
so-called  "Tubercle  corpuscle,"  as  taught  by  Prof.  Beale, 
see  page  128.  In  the  case  of  a  patient  who  died  of 
phthisis  in  the  Pennsylvania  Hospital  on  the  28th  of 
February,  1863,  I  found  several  specimens,  taken  from 
about  half  a  pint  of  purulent- looking  fluid  coughed  up 
with  a  gush  the  day  before  his  death,  composed  of 
"  Tubercle  corpuscles,"  as  above  described,  and  precisely 
identical  with  those  found  at  the  autopsy;  lining  the  inner 
surface  of  a  large  cavity  near  the  apex  of  the  left  lung. 

Of  course  the  discovery  of  elastic  tissue  in  the  sputum 
can  only  prove  the  breaking  down  of  the  pulmonary  paren- 
chyma, without  indicating  whether  this  destruction  is  the 
result  of  disintegrating  pneumonic  consolidation  or  of 
tubercular  deposit;  and  it  appears  to  me,  as  partly  sug- 
gested by  Dr.  Fenwick,  that  a  most  valuable  field  for  in- 
vestigation is  now  open  to  the  clinical  microscopist  by 
the  researches  of  F.  von  Niemeyer,  in  regard  to  the  great 


EXAMINATION  OF  SPUTUM  IN  PHTHISIS,  ETC.      221 

comparative  frequency  of  the  former  condition  alone  in 
cases  of  pulmonary  phthisis.  According  to  Niemeyer 
(Clinical  Lecture  on  Pulmonary  Phthisis,  translated  by 
J.  L.  Parke,  New  York,  1868,  p.  11),  the  products  of 
acute  catarrhal  pneumonia  occasionally,  and  chronic 
pneumonia  frequently,  instead  of  softening  and  under- 
going absorption,  become  thickened  and  metamorphosed 
into  a  caseous  mass.  In  cases  of  the  former  "the  tissue 
of  the  lung  is  not  thickened  by  an  exudation  rich  in  fibrin, 
but  by  the  filling  up  of  the  alveoli  with  young,  indifferent 
round  cells.  In  the  most  favorable  cases  this  cellular 
product  of  inflammation  undergoes  the  same  metamor- 
phosis which  the  fibrin  and  cells  imbedded  in  it  almost 
always  undergo  in  croupal  pneumonia,  viz.,  the  cells  fill 
up  with  fat,  degenerate,  and  the  contents  of  the  alveoli, 
rendered  liquid  in  this  manner,  are  reabsorbed,  so  that 
they  (the  alveoli)  become  again  permeable  to  air.  In  less 
favorable  cases  the  cellular  elements  continue  to  congre- 
gate in  the  alveoli,  the  fatty  metamorphosis  which  has 
begun  in  them  remains  incomplete,  and  the  cells  lose  their 
round  form  and  shrink  from  loss  of  water  to  irregular 
shapes.  With  these  microscopical  alterations  corresponds 
the  microscopical  change  from  the  dull,  shining  gray,  or 
grayish  red,  homogeneous  condensation  of  the  pulmonary 
tissue  into  a  dull,  yellow,  caseous  mass,  this  caseous 
material  (the  infiltrated  tubercle  of  Lannec)  in  a  minority 
of  cases  undergoing  degeneration  and  giving  rise  to  cavi- 
ties (a  process,  of  course,  accompanied  by  the  presence  of 
elastic  tissue  in  the  sputum),  which  often  have  a  tendency 
to  heal,  and,  though  sometimes  giving  rise  to  the  deposition 
of  tubercle,  have  absolutely  no  necessary  connection  with 
tuberculosis."  Indeed,  believing,  as  Niemeyer  does,  that 
"the  greatest  danger  for  most  phthisical  patients  is  that 
they  may  become  tuberculous,"  he  ventures  to  assert, 
"A  patient  who,  in  connection  with  other  symptoms  of 


222  MEDICAL  MICROSCOPY. 

pulmonary  phthisis,  expectorates  sputa  from  whose  char- 
acter we  can  infer  the  existence  of  extensive  destruction 
of  the  lung,  is  often  in  less  danger  than  a  patient  who  is 
feverish,  pale,  and  thin,  and  expectorates  only  tough, 
transparent  sputa,"  because  the  former  indicates  merely 
the  dangerous  ulceration  of  chronic  pneumonic  deposit, 
while  the  latter  points  toward  the  more  fatal  condition  of 
tuberculosis. 

While  preparing  these  pages  for  publication,  I  have 
been  fortunate  enough  to  diagnosticate  one  of  those  ob- 
scure cases  of  acute  phthisis  (which  at  first  so  closely 
simulate  enteric  fever)  simply  by  recognizing  the  lung- 
tissue  in  the  sputa.  In  this  man,  a  patient  in  the  Penn- 
sylvania Hospital,  I  found  elastic  fiber  abundant  in  the 
expectoration;  about  two  weeks  before  the  physical  signs 
or  general  symptoms  were  sufficiently  marked  to  indicate 
the  disease,  and  would  strongly  recommend  the  method 
in  similar  instances  as  promising  more  than  any  other  in 
these  difficult  problems  of  differential  diagnosis.  I  am  in- 
formed by  the  attending  physician,  James  H.  Hutchinson, 
M.D.,  under  whose  care  the  case  occurred,  that  a  full 
account  of  it  will  probably  appear  in  the  October  number 
of  the  American  Journal  of  the  Medical  Sciences  for  the 
current  year. 


CHAPTER  XI. 

EXAMINATION   OF    VOMITED    MATTERS. 

THE  examination  of  vomited  materials,  comprising  as 
they  do  the  vast  number  of  substances  employed  as  food, 
presents  many  difficulties  to  the  young  microscopist ;  and 
partly  on  this  account,  partly  from  the  fact  that  the  con- 
tents of  the  stomach  so  rapidly  undergo  change  from  the 
solvent  action  of  the  gastric  juice,  our  results,  with  a  few 
exceptions,  are  neither  so  satisfactory  nor  so  beneficial  in 
diagnosis  as  those  supplied  by  investigation  of  most  other 
evacuations.  Still,  the  use  of  the  microscope  in  regard  to 
matters  ejected  from  the  stomach  should  never  be  neg- 
lected :  since,  although  its  positive  evidence  is  often  of  but 
little  value,  the  negative  testimony  it  affords  may  some- 
times be  of  the  highest  importance;  as  in  the  following 
instance  narrated  to  me  by  a  distinguished  practitioner 
of  our  city.  In  the  course  of  a  conversation  in  relation  to 
the  advantages  of  microscopical  research,  this  gentleman 
stated  that  upon  one  occasion  a  lady  patient,  who  had 
been  for  some  months  under  his  care  with  distressing 
but  ill-defined  dyspeptic  symptoms,  sent  for  him  in  great 
haste,  and,  on  his  arrival,  exhibited  to  him  a  basin  con- 
taining nearly  a  pint  of  greenish-yellow,  creamy  fluid, 
precisely  resembling  pus,  which  she  stated  had  just  been 
ejected  from  her  stomach.  Of  course  his  first  impression 
was  that  some  internal  abscess,  so  deeply  seated  as  to 
previously  have  escaped  detection,  had  ruptured  into  the 
stomach  or  oesophagus,  to  the  imminent  risk  of  the 

(223) 


224  MEDICAL  MICROSCOPY. 

patient's  life;  but,  upon  examining  a  small  specimen  with 
a  moderate  power,  instead  of  the  pus  corpuscles  which 
he  dreaded  but  fully  expected  to  behold,  it  was  found  to 
contain  innumerable  oil  globules,  and  proved  to  be  simply 
the  result  of  an  over-distention  of  the  stomach  with  some 
indigestible  fatty  food. 

Since  vomited  matters  are  commonly  made  up  of 
numerous  different  ingredients,  more  or  less  isolated  from 
each  other,  several  specimens  taken  from  different  portions 
of  the  mass  will  often  require  examination.  If  the  ejected 
material  is  not  very  viscid,  samples  may  be  removed  by 
means  of  a  wide-mouthed  pipette,  or,  if  very  thick  and  tena- 
cious, portions  may  be  separated  by  the  assistance  of  scis- 
sors, or  a  knife  and  forceps  ;  when  obtained,  such  particles 
should  be  deposited  upon  glass  slides,  torn  out,  if  neces- 
sary, with  mounted  needles,  after  being  moistened  with  a 
drop  or  two  of  the  vomited  liquid  or  with  weak  glycerin 
and  water,  covered  with  thin  glasses,  and  examined  with 
a  power  of  from  200  to  1000  diameters.  They  will  often  be 
found  to  contain  numerous  fragments  of  partially-digested 
vegetable  and  animal  tissues,  starch  granules  (see  Fig.  14) 
from  the  different  farinaceous  articles  of  diet  being  especially 
abundant.  Care  should  be  taken  to  examine  vomit  as  soon 
as  possible  after  its  ejection  from  the  organism,  since  the 
disintegrative  processes  already  set  up  within  the  stomach 
continue  outside  the  body,  and  are  complicated  by  those 
resulting  from  the  development  of  Torula,  Vibriones,  and 
other  forms  of  fungi. 

Among  the  common  elements  of  vomited  material  may 
be  enumerated, — first,  the  epithelium  of  the  mouth,  which 
has  already  been  described  (see  page  47);  second,  the 
epithelium  of  the  oesophagus,  which  is  of  the  pavement 
variety,  having  the  same  general  characters  as  that  of 
the  mouth  and  larynx,  except  that  its  component  cells 
exceed  the  latter  in  thickness  and  in  the  number  of  their 


EXAMINATION  .OF   VOMITED  MATTERS.        225 

superimposed  layers;  third,  the  epithelium  of  the  stomach, 
consisting  of  columnar  cells  from  the  lining  membrane, 
and  large,  polygonal,  nucleated  cells  from  the  bases  of  the 
gastric  glands.  Dr.  Beale  states  that  he  has  seen  large 
flakes  of  stomach  epithelium  ejected  by  vomiting;  in  one 
severe  case  of  scarlet  fever,  a  thin  membranous  mass, 
about  three  inches  long  by  two  inches  wide,  consisting 
entirely  of  epithelial  cells,  was  thrown  off,  and  after  the 
patient's  death  the  part  of  the  surface  of  the  mucous  mem- 
brane from  which  it  was  detached,  was  discovered  on 
opening  the  stomach.  Lastly,  the  green  vomit,  so  colored 
by  the  presence  of  bile,  contains  cylindrical  epithelial 
cells,  probably  from  the  gall-ducts,  besides  the  other  forms 
of  epithelium,  with  flakes  and  small  masses  of  biliary 
coloring-matter,  and  fat  globules.  The  more  accidental 
elements  of  vomit  comprise  muscular  fibers,  which  often, 
as  the  process  of  digestion  progresses,  exhibit  a  tendency 
to  separate  into  horizontal  plates  or  disks,  somewhat  like 
the  rouleaux  of  the  red  blood  corpuscles,  instead  of  divid- 
ing longitudinally,  as  is  their  ordinary  disposition  when 
torn.  (See  Fig.  14.)  Potato  starch  granules  may  generally 
be  distinguished  from  those  of  the  cereals  by  their^  superior 
size,  since  they  average  about  7^  of  an  inch  in  length  by 
flj-Q  of  an  inch  in  breadth.  The  starch  granules  of  wheat 
may  be  most  readily  recognized  after  a  little  preliminary 
study  of  a  minute  crumb  of  bread  or  of  a  few  grains  of  flour; 
they  average  about  g^  of  an  inch  across,  but  vary  so 
much  in  their  magnitude  that  this  measurement  is  of  but 
little  value  as  a  means  for  their  detection.  Other  criteria, 
more  useful  for  their  diagnosis,  are  their  peculiar  fatty 
luster,  their  frequent  marking  with  a  little  cross  near  the 
center  of  each  granule,  and,  perhaps  best  of  all,  the  blue 
color  which  the  starches  all  assume  when  a  drop  of  a 
solution  of  iodine  is  introduced  at  the  margin  of  the  thin 
glass  cover,  and  reaches  their  surface.  (See  page  J  46.) 

20 


226  MEDICAL   MICROSCOPY. 

One  of  the  most  important  points  of  diagnosis  in  the 
examination  of  vomit  is  the  detection  of  the  blank  or  brown 
material  resembling  coffee-grounds,  which,  although  not 
pathognomonic  of  cancer  of  the  stomach,  is  yet  one  of  the 
most  valuable  signs  of  that  disease.     To  determine  their 
character  and  distinguish  these  brownish  particles  from 
fragments  of  food,  one  of  these  little  masses  which  ex- 
hibits a  reddish-brown  tint,  should,  if  possible,  be  selected, 
deposited  upon  a  slide,  pressed  out  into  a  thin  film  (see 
p.  199),  and  examined  with  a  power  of  500  diameters, 
which  will   probably  bring   into  view   the   cell-walls  of 
numerous  red  blood  corpuscles,  many  of  them  shrunken, 
pale,  and  distorted,  but  a  few  still  showing  their  normal 
bi-concave  form.     There  will  also  be  found  a  considerable 
quantity  of  dark-brown  pigment,  forming  small  aggrega- 
tions or  minute  granules,  which  probably  consist  of  the 
altered  coloring-matter  of  the  blood.     Unless  this  coffee- 
ground-like  vomit  is  accompanied  with  the  other  signs 
and  symptoms  of  gastric  carcinomatous  disease,  such  as 
the  pain  aggravated  at  night,  and,  as  well  as  the  vomiting, 
occurring  at  a  particular  interval  after  the  ingestion  of 
food,  the  cancerous  cachexia,  and  the  well-marked  tumor 
in  the  epigastric  or  right  hypochondriac  region,  it  cannot 
be  deemed  indicative  of  anything  more  than  solution  of 
continuity  of  the  internal  surface  of  the  stomach,  and  may 
point  indifferently  to  simple  ulcer,  traumatic  injury,  or 
malignant  disease      Yon  Diiben  remarks  that  the  micro- 
scope has  revealed  red  blood  corpuscles,  either  in  a  normal 
or  somewhat  wrinkled   condition,  in   the  blackish-brown 
material  ejected  from  the  stomach   as  a  consequence  of 
hemorrhagic  erosions,  of  simple  ulcer  of  the  gastric  coats, 
of  the  higher  grades  of  acute  gastritis,  of  epithelioma  and 
of  cancer,  etc. ;  the  dark  color  depending  in  part  upon 
pigment-granules,  either  free  or  inclosed  by  the  epithelial 
cells,  most  probably  the  simple  result  of  the  presence  of 


EXAMINATION  OF   VOMITED  MATTERS.         227 

haematine.  He  continues :  "The  hemorrhagic  erosion,  as 
far  as  we  know,  gives  to  the  vomited  material  no  other 
microscopical  criterion ;  but  in  ulcus  ventriculi  we  have 
twice  observed  pus  corpuscles:  in  one  case  the  quantity  of 
pus  was  so  great  as  to  form  a  thick  layer  on  the  filter. 
We  have  repeatedly  adverted  to  the  great  resemblance  of 
pus  and  mucous  corpuscles.  We  have  furthermore  stated 
that  the  latter  are  constant  elements  of  vomited  material, 
and  we  may  therefore  again  caution  the  observer.  Pus 
can  only  be  diagnosed  when  the  number  of  corpuscles  is 
very  large,  when  they  agglomerate,  and  when  they  are 
constantly  present  in  the  vomited  material,  independent  of 
meals  and  time."  (In  regard  to  the  recently  demonstrated 
identity  of  the  mucous,  pus,  and  white  corpuscles,  with  the 
means  for  distinguishing  when  practicable  the  fluids  in 
which  they  respectively  exist,  see  pages  114,  162.) 

"  In  cancer  of  the  stomach  we  have  not  yet  been  so  for- 
tunate in  establishing  any  reliable  microscopical  character. 
It  might  justly  be  supposed  that  if  a  cancerous  ulceration 
communicates  with  the  gastric  cavity,  the  structural  ele- 
ments of  the  disease  would  invariably  present  themselves 
under  the  microscope.  This  may  even  occasionally  be  the 
case,  thereby  rendering  the  diagnosis  clear  and  conclusive ; 
but  for  various  anatomico-physiological  reasons  this  expec- 
tation is  rather  uncertain.  Firstly,  because  there  is  no  spe- 
cific criterion  of  cancer;  nucleated  cells  of  great  size  and 
variable  form,  in  comparison  with  the  fundamental  structure 
of  their  source,  may  be  admitted  as  pretty  sure  indications 
of  a  cancerous  disease;  single  fragments  of  cancerous  tissue 
cannot  be  admitted  as  conclusive  evidence  of  cancer. (?) 
Secondly,  it  appears  even  admitted  that  from  a  few  scat- 
tered cancerous  fragments  a  general  diagnosis  of  cancer 
might  be  formed  by  exclusion,  but  a  cancerous  ulceration 
does  not  follow  unless  the  cancer-cells  appear  en  masse, 
because  the  disintegration  of  the  cancerous  structure  may 


228  MEDICAL   MICROSCOPY. 

«.  be  effected  by  a  fatty  degeneration  of  isolated  cells. 
Thirdly,  the  surface  of  so-called  cancerous  ulceration  is 
invariably  covered  with  a  stratum  of  cells  undergoing  fatty 
degeneration,  and  when  in  this  condition  they  are  so  much 
like  ordinary  epithelium  of  the  stomach  that  it  seems 
quite  impossible  to  discriminate  between  the  two.  And 
yet  those  cells  we  have  chiefly  to  expect  in  a  raised  ma- 
terial." 

Dr.  Beale  confirms  the  opinion  above  expressed  in  the 
following  observations,  viz.:  "  In  cases  in  which  cancer  of 
the  stomach  is  suspected,  the  vomit  should  always  be  ex- 
amined for  cancer-cells,  although  usually  these  will  be 
so  much  broken  down  as  not  to  be  recognizable.  The 
observer  must  be  careful  not  to  mistake  cells  of  columnar 
epithelium  for  cancer-cells."  In  order  to  guard  the  young 
microscopist  against  such  an  error,  I  would  remark  here, 
that,  as  will  be  more  fully  pointed  out  in  Chapter  XV., 
cancer-cells  are  to  be  distinguished  from  the  cellular 
elements  forming  the  epithelial  layer  of  mucous  mem- 
branes, not  so  much  by  their  possessing  any  particular 
form,  such  as  the  caudate,  the  oval,  or  the  multi-angular, 
but  by  their  exhibiting  a  great  variety  of  shapes  and  sizes, 
associated  together  in  close  juxtaposition,  without  order  or 
regularity,  as  if,  the  law  under  which  the  normal  tissues 
are  constructed  with  similar  and  methodically-arranged 
component  elements,  having  been  overthrown  by  the  dis- 
turbing power  of  the  malignant  growth,  each  particular 
cell,  isolated  as  regards  the  mutual  relations  which  it 
normally  bears  to  its  fellows,  progresses  with  its  own 
independent  and  irregular  development,  uncontrolled  by 
the  force  which  naturally  shapes  the  constituents  of  the 
organ.  Further,  we  may  distinguish  in  many  cases  can- 
cer-cells from  epithelial  cells, — first,  by  the  nuclei  of  the 
former  varying  greatly  in  their  relative  size  and  contour, 
and  also  in  the  fact  that  occasionally  two  or  even  three 


EXAMINATION  OF   VOMITED  MATTERS.         229 

nuclei  appear  in  the  same  cell,  which  circumstance  is  rare 
in  normal  epithelium;  and  second,  malignant  disease,  espe- 
cially when  actively  progressing,  presents  a  great  contrast 
to  any  epithelial  cell  formation  in  its  peculiar  mother-cells, 
composed  of  two,  three,  or  more  rounded  or  oval  corpuscles, 
generally  with  large  nuclei,  all  inclosed  within  a  single 
capsule,  so  as  to  constitute  in  effect  but  one  individual  cell. 
In  cases  where  either  malignant  or  benignant  tumors, 
formed  within  or  pressing  upon  the  pyloric  extremity, 
interfere  with  a  natural  evacuation  of  the  food  from  the 
stomach  into  the  duodenum,  and  therefore  compel  its 
retention  within  the  former  cavity  for  a  greater  length  of 
time  than  should  physiologically  elapse,  we  frequently 
find,  should  vomiting  take  place  some  hours  after  eating, 
that  tho  ejected  material  contains  innumerable  specimens 
of  the  Torula  cerevisiae,  or  common  yeast-plant  (Fig.  21), 
whose  spores,  being  introduced  in  large  numbers  into  the 
system,  in  bread,  cakes,  etc.,  multiply  with  great  rapidity 
when,  either  from  want  of  a  free  secretion  of  the  gastric 
juice  or  from  mechanical  detention  of  the  semi-digested 
element  within  the  gastric  cavity,  circumstances  abnor- 
mally favor  its  development.  This  alga  will  probably  be 
more  readily  recognized  by  the  student  if  he  compares  it 
with  a  few  specimens  of  the  growing  plant  as  found  in 
yeast  from  the  kitchen  (see  Chapter  IV.).  When  once 
naturalized  within  the  stomach  it  is  sometimes  extremely 
difficult  to  dislodge,  giving  rise  to  most  of  the  symptoms 
characterizing  dyspepsia,  by  both  promoting  and  causing 
gastric  fermentation.  Its  spores  may  be  distinguished 
from  red  blood  globules,  which  they  resemble  in  size,  by 
their  generally  oval  shape,  and  by  the  appearance  of  gran- 
ular contents  in  molecular  movement,  which  the  largest 
ones  present  under  a  high  power.  They  differ  from  fat 
globules,  for  which  they  might  be  mistaken  on  account  of 
their  fatty  luster,  in  their  tendency  to  aggregation  in  rows, 

20* 


230  MEDICAL  MICROSCOPY. 

each  individual  joined  to  its  neighbors  by  the  extremities 
of  its  long  diameter ;  likewise  by  their  insolubility  in  ether, 
which  at  once  dissolves  the  fatty  particles. 

FIG  21. 


TORULA  CERETJSI^— YEAST-PLANT.    (After  Bird,  taken  from  Funke.) 
X  about  200  Diameters. 

Yon  Diiben  states  that  one  of  the  most  valuable,  in  fact 
"the  only  remedy  against  it,  well  known  by  the  populace, 
is  whisky,  which  chemically  disturbs  the  formation  of  alco- 
hol" (the  alga?). 

According  to  the  observations  of  Prof.  C.  Reisz,  of 
Copenhagen  {Northern  Medical  Archives,  Stockholm, 
1869;  Medico- Ghirurgical  Review,  April,  1870),  the 
Thrush  fungus,  Oidium  albicans,  described  in  Chapter 
VIII.  p.  166  et  seq,,  is  not  always  limited,  as  maintained 
by  F.  Berg,  to  the  tessellated  epithelium  of  the  month, 
throat,  and  oesophagus,  but  may  occasionally  develop 
among  the  epithelial  cells  of  the  stomach,  and  there  give 
rise  to  a  "  Gastritis  aphthosa,"  with  the  ordinary  symptoms 
of  nausea,  pain,  and  indigestion.  See  also  case  reported 
by  Zalesky  (Virchow's  Archives,  Band  xxxi.  p.  426.) 


EXAMINATION   OF   VOMITED  MATTERS.         231 

The  Sarcina  vcntriculi  wns  first  discovered  by  Dr.  John 
Goodsir,  of  Edinburgh,  who  published  a  very  complete 
and  able  report  of  the  case  in  which  it  occurred  iu  the 
Edinburgh  Medical  and  Surgical  Journal,  vol.  Ivii.,  Ediu., 
1842.  He  describes  the  plant  as  follows : 

"  Sarcina,  plants  coriaceous,  transparent,  consisting  of 
sixteen  to  sixty-four  four-celled,  square  frustules,  ar- 
ranged parallel  to  one  another  in  a  square,  transparent 
matrix.  Species  1.  Sarcina  ventriculi,  mihi,  Frustules 
16,  color  light  brown,  transparent  matrix  very  percep- 
tible between  the  frustules,  less  so  around  the  edges; 
size,  800  to  1000  inch.  Hab.,  the  human  stomach." 
(See  Fig.  22.) 

In  a  case  where  Sarcinae  were  detected  in  the  vomited 
matter,  occurring  in  the  Pennsylvania  Hospital  during  the 
summer  of  1869,  the  attending  physician,  Dr.  J.  Forsyth 
Meigs,  suspected  at  once  the  existence  of  the  alga  from  the 
appearance  of  the  vomit,  which,  on  microscopic  examina- 
tion, exhibited  this  remarkable  vegetable  organism  in  great 
abundance.  The  fluid  ejected  from  the  stomach,  in  this 
instance,  was,  as  described  by  Goodsir  and  other  authori- 
ties, thin,  transparent,  and  almost  colorless,  while  upon  its 
surface  floated  an  abundant  scum,  reddish-brown  in  color, 
and  strongly  resembling  that  seen  upon  beer  when  a  portion 
of  the  froth  has  subsided  by  standing. 

If,  in  any  patient,  obstinate  vomiting  occurs  without 
apparent  cause,  and  the  material  ejected  presents  this  pecu- 
liar brownish  froth,  either  at  first  or  after  some  hours  of 
repose,  the  presence  of  Sarcinas  may  always  be  looked  for, 
and  they  can  'generally  be  discovered  by  careful  micro- 
scopical examination.  According  to  Beale,  "the  vomited 
matters  in  which  it  occurs  have  usually,  but  not  invaria- 
bly, very  much  the  appearance  of  yeast,  and  fermentation 
proceeds  for  some  time  after  they  have  been  ejected.  In 
vomit  presenting  these  characters  the  Sarcinse  are,  I  be- 


232  MEDICAL  MICROSCOPY. 

lieve,  never  absent;  but  they  have  been  found  in  other  cases 
and  in  other  situations :  by  Lebert  in  a  case  of  cancer  ac- 
companied with  black  vomiting,  and  by  myself  in  a  case  in 
which  there  was  a  very  abundant  ejection  of  coffee-ground 
vomit  for  a  few  days  before  death.  In  this  vomit  the  SarcinaB 
were  very  abundant,  but  there  was  no  fermentation."  They 
have  also  been  detected  frequently  in  faeces,  occasionally 
in  the  renal  secretion,  in  cavities  of  the  lung,  in  the  ven- 
tricles of  the  brain,  etc.  Kiichenmeister  directs,  as  a 
method  of  observation,  that  the  matter  containing  the 
plant  should  be  collected  in  any  convenient  manner, 
allowed  to  stand  at  rest  for  some  hours,  the  deposit  re- 
moved by  means  of  a  pipette,  placed  upon  a  slide  covered 
with  thin  glass,  and  examined  with  a  magnifying  power 
of  not  less  than  six  hundred  diameters  ;  although  for  care- 
ful study  even  much  greater  amplification  is  useful,  I  have 
generally  found  it  quite  easy  to  detect  this  entophyte  with 
a  quarter-inch  objective  magnifying  about  200  times.  The 
fluid  in  which  Sarcinae  flourish  has  generally  an  acid  re- 
action, and  even  in  those  cases  where  the  bulk  of  vomited 
matter  is  alkaline  we  will  generally  find  the  brown  flocculi 
containing  the  alga  are  intensely  acid.  Although  Dr. 
Goodsir,  from  the  time  he  first  discovered  this  organism, 
maintained  its  vegetable  nature,  Busk  and  Link  regarded 
the  Sarcina  as  an  animal  belonging  to  the  genus  Gonium, 
and  Schlossberger  asserted  that  it  was  nothing  more  than 
primitive  muscular  fiber  which  had  undergone  partial  dis- 
integration. Virchow,  however,  proved  that  the  cubes  of 
Sarcinae  were  much  larger  than  any  which  could  result 
from  the  decomposition  of  muscle,  and  also  that  the  mus- 
cular fiber  entirely  disappeared  when  macerated  in  water 
or  in  acetic  acid,  whilst  Sarcinaa  remained.  In  regard  to 
the  hypothesis  that  it  is  a  product  of  animal  tissue  which 
has  undergone  a  sort  of  fatty  degeneration,  any  one  can 
satisfy  himself  of  its  fallacy  by  digesting  tfre  plant  in  sul- 


EXAMINATION   OF   VOM1TKI)   MATTERS.         283 

phuric  ether,  which  is  without  action  upon  it.     According 
to  Sir  Thomas  Watson  (Practice  of 
Physic,  p.   881),  Dr.  Budd  believes  FIG.  22. 

the  disease  to  consist  essentially  "  in 
some  organic  change  which  prevents 
the  stomach  completely  or  readily 
emptying  itself,  and  which  causes  a 
secretion  from  the  coats  of  the 
stomach,  capable,  when  mixed  with 
the  food,  of  undergoing  or  of  excit- 
ing a  fermentative  process,  and  that 
the  development  of  the  Sarcina  bears  Diameters. 
to  this  fermentative  process,  or  to  «. Bwretaa.  &. gtwch gr»»- 

.    ..      .,  ,    ,.          ulos,  partially  dissolved  and 

some  stage  of   it,  the  same  relation  rcn(]ered    transparent.     c. 
as  the  development  of  Torula  bears  Minute  oval  fungi,  usually 

,  ,       ,      v         f  *.••«!  present  with  Sarcina.    d.  Vi- 

to  simple  alcoholic  fermentation."  brione8  e  Oil  globuleg  f 
Indeed,  both  Mr.  Berkeley  and  Dr.  starch  (wheat)  globule,  from 
John  Lowe  are  of  the  opinion  that  ^'edc"lcked  but  not  yet 
the  Sarcina  is  only  a  very  common 
microscopic  fungus  in  a  very  peculiar  form,  and,  accord- 
ing to  Dr.  Beale,  Dr.  Brinton  and  Dr.  Tilbury  Fox  re- 
gard it  as  a  modification  of  Penicillium,  and,  therefore, 
an  ordinary  mould,  in  which  view,  however,  he  cannot 
agree. 

Dr.  Beale  states  that  "  various  plans  of  treatment  have 
been  employed  to  prevent  the  development  of  Sarcina?,  but 
hitherto  with  very  imperfect  success.  Hyposulphite  of 
soda  has  been  found  advantageous  in  some  cases,  but  the 
disease  was  not  cured.  Great  relief  to  the  burning  sensa- 
tion which  frequently  occurs  in  these  cases  is  experienced 
by  the  use  of  large  doses  of  common  salt."  Prof.  George 
B.  Wood  (Practice  of  Medicine,  vol.  i.  p.  596)  remarks : 
"The  sulphite  of  soda  may  be  given  in  the  dose  of  a 
drachm  three  times  a  day  or  oftener.  But  it  is  obvious 
that  the  cure  must  be  effected,  if  at  all,  by  measures  ad- 


234  MEDICAL  MICROSCOPY. 

dressed  to  the  pathological  condition  of  the  stomach.  I 
have  had  under  my  care  a  similar  case  (of  yeasty  vomit- 
ing) in  the  Pennsylvania  Hospital,  which  was  discharged 
apparently  well,  after  a  treatment  of  several  months  with 
nitrate  of  silver.  The  presence  of  an  acid  in  the  gastric 
liquors  favors  the  production  of  the  Sarcinae,  which  cease 
to  appear  when  the  liquid  is  rendered  alkaline.  Dr.  Geo. 
Budd  has  found  creasote  useful  in  yeasty  vomiting ;  and 
common  salt  has  also  in  his  hands  proved  destructive  of 
the  fungus."  The  cases  coming  under  my  own  notice 
have  generally  been  either  greatly  relieved,  or  apparently 
cured,  by  perseverance  in  the  use  of  sulphite  and  bisul- 
phite of  soda,  creasote  mixture,  etc.,  as  directed  by  Prof. 
Wood. 


CHAPTER   XII. 

EXAMINATION    OF    ANAL,    VAGINAL,    AND    UTERINE 
DISCHARGES. 

THE  constituents  of  faecal  and  other  evacuations  from  the 
bowels,  comprising  as  they  do  so  many  different  articles 
of  food,  altered  in  such  a  variety  of  ways  and  degrees 
during  the  process  of  digestion,  are  sometimes  absolutely 
unrecognizable  even  to  the  skilled  observer,  and  of  course 
present  many  problems  of  extreme  difficulty  to  the  inex- 
perienced microscopist. 

As  in  some  instances  the  detection  of  red  blood  cor- 
puscles or  of  Leucocytes  will  throw  important  light  upon 
the  case,  it  is  advisable  that  the  specimen  of  faces  to  be 
examined  should  not  be  brought  in  contact  with  water  or 
urine,  lest  its  cellular  elements  undergo  alteration  by  the 
process  of  endosmosis;  a  minute  fragment,  perhaps  the 
size  of  a  small  pin's-head,  should  therefore  be  placed  upon 
a  slide,  and  broken  down  with  mounted  needles,  in  a  drop 
of  weak  syrup  or  glycerin  and  water  of  the  sp.  gr.  of 
1028  (see  page  37),  until  it  is  reduced  to  a  perfectly  fluid 
consistence,  when  it  should  be  covered  with  thin  glass 
and  subjected  to  examination  upon  the  stage  of  the  micro- 
scope, with  a  power  of  lifjO,  or  preferably  of  500  or  more, 
diameters. 

The  detection  of  red  blood  corpuscles  in  faeces  prepared 
with  the  precautions  above  detailed  is,  as  a  rule,  easy  in 
an  inverse  proportion  to  the  distance  within  the  anus  that 
they  have  been  effused,  and  the  consequent  length  of  time 

(235) 


236  MEDICAL  MICROSCOPY. 

they  have  been  exposed  to  the  solvent  action  of  the  in- 
testinal juices;  that  is,  if  hemorrhage  has  taken  place,  from 
ulceration  of  the  bowel,  mechanical  injury,  or  any  other 
cause,  within  the  rectum  or  colon,  the  disks  will  generally 
be  found  to  maintain,  in  a  great  degree,  their  normal  shape 
and  color,  while  should  the  sanguineous  discharge  have 
occurred  higher  up  in  the  ilium,  and  a  fortiori  in  the 
jejunum,  the  globules  will  often  be  so  far  disintegrated  that 
they  are  scarcely  recognizable.  When  such  is  the  case, 
assistance  may  often  be  obtained  from  the  use  of  solution 
of  aniline,  which  frequently  suffices  to  bring  the  distorted 
or  fragmentary  cell-walls  (see  page  176)  of  the  decolorized 
and  broken-down  globules  into  view.  The  pathological 
indications  of  blood  in  the  stools  of  course  vary  greatly 
with  its  amount,  accompanying  symptoms  (such  as  pain, 
soreness,  elevation  of  temperature),  and  with  the  history 
of  the  patient.  Thus,  for  example,  if  the  disease  is  of 
recent  origin,  the  pain  felt  near  the  fundament  most 
severely  at  the  time  of  going  to  stool  and  shortly  after- 
wards, and  the  amount  of  blood  small,  careful  examination 
should  be  instituted  for  fissure  of  the  anus.  If  the  flow  of 
blood  is  abundant,  internal  piles  may  be  suspected ;  if  the 
red  disks  are  mingled  with  a  great  quantity  of  Leucocytes, 
and  especially  if  the  patient  is  of  a  tuberculous  diathesis, 
fistula  in  ano  must  be  searched  for;  and  should  the  dis- 
ease be  of  long  standing,  the  pain  aggravated  at  night,  and 
the  so-called  cancerous  cachexia  at  all  marked,  suspicions 
of  carcinoma  of  the  rectum  or  colon  may  be  entertained. 
When  the  sanguineous  effusion  occurs  from  some  point 
higher  up  in  the  intestines,  the  abdominal  seat  of  the  pain, 
the  liquid  character  of  the  frequent  discharges,  and  the 
more  disintegrated  state  of  the  corpuscles  will  all  point  to 
the  more  internal  position  of  the  disease.  On  the  other 
hand,  microscopic  examination  sometimes  affords  important 
aid  to  diagnosis,  by  enabling  us  to  exclude  the  considera- 


ANAL,   VAGINAL,  AND    UTERINE  DISCHARGES.     237 

tion  of  true  nu-hiMisi,  in  the  investigation  of  faecal  matter, 
colored  black  by  the  internal  use  of  iron,  green  by  the 
administration  of  mercurials,  or  of  indigo,  and  by  the  ex- 
cessive secretion  of  bile  ;  or  red  by  the  ingestion  of  black- 
berries, raspberries,  etc.,  or  the  medicinal  employment  of 
Haematoxylon  and  its  preparations,  etc. 

The  occurrence  of  pseudo-membranous  or  mucous  forma- 
tions in  the  evacuations  of  the  bowels,  although  not  very 
common,  at  least  in  this  city,  is  apt,  when  it  does  take 
place,  to  cause  no  little  anxiety  to  both  patient  and  phy- 
sician. In  a  case  I  saw  in  consultation  some  years  since 
in  Western  New  York,  the  patient,  a  middle-aged  married 
lady,  as  well  as  her  doctor,  was  firmly  convinced  that  the 
tubular  membranes  discharged  were  portions  of  her  bowels, 
which  were  ulcerating  rapidly  away;  and  so  strong  was 
this  impression  that  my  positive  assurance,  founded  on 
careful  examination  of  several  specimens  (in  which  I  was 
able  to  establish  the  existence  of  an  obscurely  fibrillated 
and  granular  material  wherein  a  few  epithelial  cells  and 
mucous  corpuscles  were  imbedded,  without  any  of  that 
regularity  of  arrangement  which  characterizes  the  epithe- 
lial layers  of  a  mucous  membrane),  only  in  part  persuaded 
her  that  her  agonizing  dread  lest  her  "insides"  were  all 
coming  away  piecemeal  was  unfounded.  Dr.  Beale  re- 
marks, in  regard  to  these  mucous  casts,  that  they  some- 
times form  complete  tubes,  and  that  flakes,  some  of  which 
are  very  firm,  are  common  enough,  especially  after  pro- 
longed constipation.  He  details  a  case  in  which  tubular 
casts  of  this  nature  were  passed  by  a  child  four  years  old, 
without  giving  rise  to  any  urgent  symptoms.  On  micro- 
scopic examination,  the  tissue  was  found  to  be  composed 
of  very  firm  mucus,  in  which  numerous  cells  of  epithelium 
from  the  large  intestines  were  imbedded.  (See  also  refer- 
ences to  similar  cases  of  fibrinous  casts  found  in  the  lacteal 
ducts  of  the  female  mammae,  and  in  the  bronchial  tubes  of 

21 


238  MEDICAL  MICROSCOPY. 

the  lung,  on  page  173.)  Dr.  Bennett,  in  his  work  on  Clin- 
ical Medicine,  observes:  "In  a  disease  very  common  in 
Edinburgh,  especially  in  women,  flakes  of  membranous 
matter  are  thrown  off  in  large  quantities ;  these  present  a 
very  similar  appearance  to  the  cholera  flakes  just  noticed," 
viz. :  "  mucus  in  which  the  debris  of  epithelial  cells  is 
entangled;  and  as  the  nuclei  of  these  cells  resist  disin- 
tegration for  a  long  time,  these  round  or  oval  bodies 
generally  exist  in  considerable  number."  Yon  Duben 
asserts  that  the  discharges  in  dysentery  are  characterized 
by  blood  and  pus  corpuscles,  either  isolated  or  connected 
in  membranes  by  a  coagulable  material. 

Among  other  ingredients  of  the  intestinal  evacuations 
which  may  be  mistaken  for  these  membranous  flakes,  at 
least  on  a  naked-eye  inspection  alone,  may  be  mentioned 
the  skins  of  various  fruits  and  vegetables  employed  as 
food  ;  an  interesting  example  of  this  kind  being  narrated 
by  Dr.  Bennett,  as  follows:  "An  individual  was  supposed 
to  be  laboring  under  dysentery  from  the  frequent  passage 
of  yellowish  pulpy  masses  in  the  stools,  accompanied  with 
tormina  and  other  symptoms.  On  examining  these  masses 
with  the  microscope,  I  found  them  to  consist  of  undigested 
potato-skins.  On  inquiry,  it  was  ascertained  that  this 
person  had  eaten  the  skins  with  the  potatoes.  On  causing 
these  to  be  removed  before  dinner,  the  alarming  appearance 
ceased,  and  the  other  symptoms  also  disappeared." 

According  to  Yon  Diiben,  "Gelatinous,  mucous,  and 
rice  bodies  sometimes  occur  in  alvine  evacuations.  They 
are  secreted  by  the  follicles  of  the  large  intestine,  and  they 
characterize  themselves  by  the  presence  of  small  round  or 
oval,  pale  and  granulated  cells,  besides  numerous  isolated 
granules  imbedded  in  the  amorphous  mucus."  The  micro- 
scopical discrimination  from  ingesta  may  have  some  inter- 
est and  value  in  the  treatment  of  infants.  The  recognition 
of  pus  in  the  evacuations  of  the  bowels  is  necessarily 


ANAL,   VAGINAL,  AND    UTERINE  DISCHARGES.      239 

extremely  difficult,  few  cases  occurring  in  which  a  suffi- 
cient quantity  of  the  liquid  can  be  obtained  free  enough 
from  faecal  matter  to  admit  of  the  application  of  chemical 
tests,  such  as  nitric  acid  or  liquor  potassa,  by  which  alone 
we  can  discriminate  with  certainty  between  mucus  and 
pus.  Sometimes,  however,  a  small  streak  of  dense  yellow 
liquid  filled  with  Leucocytes,  occurring-  constantly  upon 
one  particular  side  of  a  cylindrical  mass  of  hardened  faeces, 
will  point  to  an  ulcer  or  the  mouth  of  a  fistula,  and  so 
contribute  to  the  accuracy  of  diagnosis. 

In  the  alvine  dejections  of  typhus,  typhoid,  and  some 
putrid  fevers,  crystals  of  Triple  Phosphate  are  frequently 
met  with  in  great  number;  also,  as  stated  by  Dr.  Beale, 
altered  blood,  and  vast  numbers  of  Yibriones  with  different 
kinds  of  vegetable  fungi,  are  not  uncommonly  found. 
Among  these  occasionally  occurs  the  Sarcina  ventriculi. 
(See  page  231.)  Dr.  Bennett  relates  the  following  ex- 
ample of  a  vegetable  production  developed  within  the 
alimentary  canal.  "  On  one  occasion  a  dispensary  patient 
brought  to  me  a  membranous  mass  which  had  been 
evacuated  by  the  bowels.  It  resembled  a  piece  of  boiled 
fine  leather,  of  a  greenish-yellow  color  and  fibrous  struc- 
ture. On  microscopic  examination  it  was  found  to  be 
made  up  of  an  inextricable  mesh-work  of  confervoid 
growths,  consisting  of  long  tubes  with  joints  and  a  few 
oval  sporules,  the  former  having  a  great  tendency  to 
break  across."  Von  Diiben  remarks  that  the  fragments  of 
typhus  scabs  (Enteric  fever?)  characterize  themselves  by 
densely-grouped  molecules,  derived  from  decaying  cells 
and  nuclei,  besides  crystals  of  animonio-magnesian  phos- 
phates. 

Among  the  Infusoria  said  to  occur  in  the  intestines 
may  be  mentioned  the  species  discovered  by  Malmsten,  of 
Stockholm,  and  named  by  him  Paramoecium  Coli.  It  is 
described  as  being  about  -^  of  an  inch  in  length,  oval  in 


240  MEDICAL  MICROSCOPY. 

form,  containing  a  nucleus,  and  covered  externally  with 
cilia.  Prof.  Malmsten  believes  that  the  immense  numbers 
and  restless  activity  of  these  parasites  render  them  well 
calculated  to  increase  peristaltic  motion  and  intestinal 
secretion,  and  consequently  to  cause  diarrhoea.  He  sug- 
gests that  the  fact  that  they  have  not  been  noticed  more 
frequently  before  is  probably  no  evidence  of  their  rare 
occurrence,  but  owing  to  their  rapid  decay  after  they  leave 
the  rectum.  As  suggested  by  Yon  Diiben,  "  It  is  there- 
fore a  material  condition  in  respect  to  microscopical  exami- 
nation, that  the  faeces  should  be  submitted  to  it  without 
delay,  unless — and  this  is  preferable — mucus  from  the 
rectum  be  taken." 

The  microscope  may  often  be  called  into  requisition  to 
determine  whether  bodies  resembling  intestinal  worms  are 
really  portions  of  Entozoa  from  the  alimentary  canal,  and 
especially  is  it  of  service  in  the  recognition  of  the  ova  of 
these  parasites. 

Of  the  Entozoa,  probably  by  far  the  most  common  are 
the  Ascaris  lumbricoides  (Long  round  worm),  classed  by 
Kuchenrneister  (Manual  of  Parasites :  Sydenham  Society's 
translation,  London,  1857,  vol.  i.  page  409),  following 
Dujardin,  as  a  nematode  worm,  and  described  as  having  a 
white  or  yellowish,  nearly  cylindrical  body,  attenuated  at 
each  end,  with  four  whitish,  opaque,  longitudinal  striae, 
equidistant  from  each  other;  the  skin  is  marked  with  trans- 
verse grooves,  somewhat  resembling  those  of  the  ordinary 
earthworm,  but  very  much  closer  together.  The  head  is 
at  the  smaller  extremity,  and  may  be  recognized  by  its 
three  prominent  papilla,  which  act  as  suckers  during  life. 
The  male  is  smaller  than  the  female,  averaging  about  five 
inches  in  length,  and  is  characterized  by  his  comparatively 
slender,  sharply-curved  tail,  near  the  extremity  of  which 
may  often  be  seen  a  pair  of  delicate  white  projecting  hairs, 
the  organs  of  generation.  The  female  averages  at  least 


ANAL,    VAGINAL,  AND    UTERINE  DISCHARGES.      241 

twelve  inches  in  length,  and  may  be  recognized  by  the 
external  genitals  seated  about  one-third  of  the  entire  dis- 
tance from  the  cephalic  extremity.  The  ova  of  this  para- 
site, with  which  especially  a  microscopist  has  to  deal,  are 
of  a  rounded  form,  about  -^  of  an  inch  in  diameter  when 
mature,  and  furnished  with  a  thin  but  firm  envelope.  (See 
Fig.  23,  a.) 

Fia.  23. 


OVA  OF  INTESTINAL  WORMS.  (After  Bealo  and  Lcuckart.) 

a.  Ovum  of  Ascaris  Lumliricoides  (Round  worm),  X  370  Diameters,  b.  Ditto  of 
Oxyuris  Vermicularis  (Scat-worm),  X  215  Diameters,  c.  Ditto  of  Taeuia  Solium, 
(Tapeworm),  X  370  Diameters. 

The  Ascaris,  or  Oxyuris  vermicularis,  vulgarly  called 
the  thread  or  seat  worm,  is  the  smallest  of  this  class  of 
parasites,  the  male  not  averaging  more  than  one-sixth,  and 
the  female  not  more  than  half  an  inch  in  length ;  the  head 
is  furnished  with  a  three-lipped  mouth,  which  is  rounded 
when  contracted,  and  triangular  in  an  active  state  In 
addition  to  the  characteristic  of  size,  the  sexes  may  be  dis- 
tinguished by  the  shape  of  the  tail,  which  is  sharp  in  the 
female,  while  in  the  male  it  is  obtuse  and  twisted  into  a 
spiral  form.  The  eggs  are  light,  oblong,  somewhat  irregu- 
lar in  shape,  and  measure  from  -^-$  to  -^  of  an  inch  in 
length.  It  must  not  be  forgotten  that  these  minute  worms 
sometimes  desert  their  usual  seat  in  the  rectum  and  enter 
the  vagina,  where  they  may  give  rise  to  very  severe  irri- 
tation, the  true  cause  of  which,  microscopic  examination 

21* 


242  MEDICAL  MICROSCOPY. 

of  the  leucorrhoea-like  discharge,  by  revealing  the  eggs  or 
larva  therein,  may  at  once  disclose. 

The  Taenia  Solium,  whose  wonderful  life  history  has 
been  so  carefully  investigated  by  the  great  German  hel- 
minthologist,  can  hardly  be  classed  among  microscopic 
objects,  since  its  joints  may  almost  always  be  recognized, 
on  careful  inspection  of  stools  in  which  they  exist,  with  the 
unassisted  eye.  According  to  Yon  Diiben,  the  ova  of 
Tsenia  Solium  (Fig.  23,  c)  are  almost  circular,  of  0'033  mill. 
(r5T  of  an  inch)  in  diameter.  (Kiichenmeister  gives  the  di- 
mensions as  follows:  "Eggs,  0*036  of  a  millimetre  in 
length  by  0'036  to  0'043  of  a  millimetre  in  width.")  "The 
membrane  (capsule  ?)  upon  the  application  of  a  low  power 
and  false  focus  shows  parallel  lines  which  cross  each  other 
at  right  angles ;  with  considerably  increased  power  we 
notice  that  the  exterior  coat  consists  of  hexagonal  parallel 
plates,  with  dark  spots  in  the  center.  In  most  of  them  we 
found  embryonic  hooks.  The  presence  and  the  general 
structure  of  the  ovum  are  sufficient  for  the  practical  pur- 
poses of  diagnosis."  In  making  an  examination  of  fseces  for 
the  entozoa  or  their  ova,  he  advises  that  the  medical  at- 
tendant should  administer  to  the  patient,  in  whom  they  are 
suspected  to  exist,  a  drastic  cathartic,  and  on  its  operation 
subject  the  excrement  to  careful  microscopic  examination. 
The  ova  are  usually  found  in  the  mucus,  which  should  be 
investigated  with  a  low  power,  of  say  1 00  or  1 50  diameters, 
to  enable  one  to  make  a  rapid  search,  and  on  discovering 
an  object  resembling  any  of  the  figures  above  given,  a 
higher  objective  should  be  screwed  on,  and  the  structure 
carefully  examined. 

The  same  author  justly  remarks  that  "the  public  is 
readily  disposed  to  take  everything  that  passes  the  anus 
for  an  intestinal  worm  which  presents  an  unusual  appear- 
ance, and  we  have  received  many  objects  for  examination 
which  have  been  sent  with  this  view.  In  two  cases  we 


ANAL,   VAGINAL,  AND    UTERINE  DISCHARGES.      243 

found  fragments  of  linen  imbedded  in  mucus  and  faces. 
Mere  washing  revealed  their  nature.  A  pretty  thick  linen 
thread,  cut  into  inch-long  pieces,  had  been  swallowed  by  a 
child  and  passed  oft*  in  three  or  four  days.  The  frightened 
parent  was,  however,  comforted  by  our  showing  the  fibrillse 
of  the  thread.  In  another  case,  cellular  tissue  was  the 
cause  of  alarm,  which  was  of  course  at  once  recognized  by 
the  microscope.  Again,  the  same  element  derived  from 
meat-balls  was  presented  to  us.  In  another  instance  a 
number  of  small,  white,  equally  wide  pieces  were  handed 
us,  which  by  appearance  looked  as  much  like  tapeworm  as 
could  be  imagined.  The  magnifying  glass,  however,  suf- 
ficed to  destroy  the  supposition,  and  the  microscope  dis- 
closed the  true  nature  of  lichen  islandicus.  In  one  case 
Professor  Buhl  observed  mucus  to  have  undergone  such 
changes  as  almost  to  simulate  tapeworm.  But  these  ex- 
emplifications will  suffice.  To  such  delusions  we  can 
hardly  count  the  case  of  Professor  Huss,  who  observed  for 
a  period  the  discharge  of  fibers  which  proved  to  be  adi- 
pose tissue  very  like  that  of  lipomas.  We  doubt  whether 
these  elements  had  been  introduced  from  without,  and  in- 
deed if  they  were  we  should  be  unable  to  account  for  their 
true  nature.  Perhaps  they  originated  in  a  lipoma  of  the 
intestinal  canal  disintegrating  and  passing  off  in  frag- 
ments." 

The  occurrence  of  fatty  matter  in  the  stools,  either  in 
the  shape  of  microscopic  oil  globules  or  molecules,  or  in 
masses  visible  to  the  naked  eye,  is  not  very  uncommon, 
and  is  usually  attributed  to  derangement,  functional  or 
organic,  of  the  pancreas.  In  a  case  which  came  under  my 
own  observation  a  few  months  since,  the  patient,  a  young 
gentleman  about  seventeen  years  old,  experienced  intense 
pain  in  the  rectum  during  and  subsequent  to  each  evacua- 
tion, which  was  accompanied  by  a  discharge  of  whitish 
semi-solid  matter.  On  microscopic  examination  of  portions 


244  MEDICAL  MICROSCOPY. 

of  this  substance,  it  was  found  to  consist  of  columnar 
epithelium,  mucous  corpuscles,  etc.,  from  the  alimentary 
tract,  imbedded  in  a  translucent,  highly  refractive  material, 
which,  on  the  application  of  a  few  drops  of  ether,  intro- 
duced at  the  margin  of  the  cover,  was  seen  to  be  readily 
soluble  in  that  reagent,  and  on  testing  a  larger  quantity  in 
a  similar  manner  its  oleaginous  nature  was  fully  demon- 
strated by  its  free  solubility  and  subsequent  deposition  in 
distinct  oil-drops,  when  a  little  of  the  ethereal  solution 
was  allowed  to  evaporate  upon  a  clean  slide.  The  micro- 
scopic investigation  here,  as  far  as  the  difficulty  near  the 
anus  was  concerned,  was  chiefly  valuable  in  disproving 
the  presence  of  pus,  which  had  been  deemed  extremely 
probable  from  the  naked-eye  appearances,  and  upon  which 
a  provisional  diagnosis  of  incomplete  fistula  in  ano  had 
been  predicated. 

In 'the  examination  of  VAGINAL  mucus,  and  other  dis- 
charges- from  the  vulva,  it  is  advisable,  as  suggested  by 
Dr.  Beale,  to  avoid  the  addition  of  any  fluid  of  lower  spe- 
cific gravity  than  that  of  the  liquor  muci,  lest  important 
changes  be  produced  in  the  appearance  and  characteristics 
of  the  corpuscular  and  parasitic  bodies  which  they  happen 
to  contain;  should  it  be  necessary  therefore,  on  account  of 
the  opacity  of  any  discharge,  to  dilute  it  with  a  transparent 
fluid,  a  weak  solution  of  sugar  or  glycerin  in  water  (see 
p.  37)  must  be  employed.  Thus,  for  example,  the  Tricho- 
monas  vaginalis,  described  by  Dujardin  and  Donne,  was 
for  a  long  time  considered  by  many  microscopists  to  be 
simply  a  ciliated  epithelial  cell  (probably  because,  as  ob- 
served by  Ku'chenmeister,  they  examined  it  during  its 
contact  with  water,  or  very  weak  sugar  and  water,  in 
which  the  animals  swell  up  into  a  globular  form  and  soon 
become  motionless,  closely  resembling  ciliated  cells);  now, 
however,  it  has  been  shown  by  Kolliker  and  Scanzoni  that 
it  is  unquestionably  an  independent  organism.  These 
gentlemen  found  it  in  vaginal  (never  in  cervical)  mucus,  of 


.I.V.I/,,    VAGINAL,  AND    UTERINE  DISCHARGES. 

both  pregnant  and  un impregnated  women,  especially  in 
the  yellowish,  creamy,  acid  mucus,  sometimes  in  neutral 
but  never  in  alkaline  mucus.  Kiichenmeister  states  that 
"it  only  occurs  in  women  with  gonorrho3al  discharge,  or 
with  an  abundant  vaginal  secretion,  mixed  with  mucous 
and  pus  corpuscles;  never  in  normal  and  healthy  fluids 
of  the  vagina,  but  only  in  pathological  conditions.  The 
mucus,  however,  need  not  be  frothy,  as  Donne  supposes,  so 
long  as  it  is  not  quite  normal.  From  their  granulated 
appearance,  their  form,  size,  and  structure,  the  mucous 
corpuscles  closely  resemble  this  infusorium;  they  also 
generally  lie  in  masses  together.  All  these  things,  with 
the  very  sluggish  movements  of  the  parasite,  have  caused 
it  to  be  very  commonly  overlooked  and  confounded  with 
the  mucous  corpuscles.  The  prolongation  at  the  anterior 
end,  which  is  even  sometimes  drawn  out  into  an  elliptical 
form  and  furnished  with  a  delicate  long  filament  (flagel- 
lurti),  distinguishes  the  parasite  from  the  epithelium." 

The  ordinary  ingredients  of  all  vaginal  discharges  of 
course  include  the  cast-off  epithelial  cells  from  the  uterine 
mucous  membrane  and  from  that  lining  the  Fallopian  tubes ; 
these  differ  from  the  squamous  cells  (similar  to  those  de- 
scribed on  p.  47)  of  the  vagina  in  being  columnar  and 
ciliated,  a  peculiarity  which  it  requires  a  good  objective 
and  some  experience  in  microscopy  to  detect.  Indeed,  I 
would  advise  the  student  to  familiarize  himself  on  the  first 
opportunity  with  ciliae  and  their  remarkable  movement,  by 
the  study  of  a  few  cells  scraped  from  the  "beard"  of  an 
oyster  and  examined  in  a  little  of  the  animal's  own  liquor. 
In  addition  to  these  forms  of  epithelium  and  the  rounded 
cells  from  the  numerous  glands  which  occupy  the  vaginal 
walls,  there  appear  necessarily  during  the  menstrual  period 
multitudes  of  red  and  white  blood  corpuscles,  which,  how- 
ever, present  no  peculiarities  which  may  serve  to  positively 
distinguish  them  (see  p.  175).  In  the  case  of  Sarah  J. 


246  MEDICAL   MICROSCOPY. 

W.,  a  young  girl,  aged  15,  operated  on  in  July,  1870,  at 
the  Pennsylvania  Hospital  (by  Prof.  D.  H.  Agnew,  one  of 
the  attending  surgeons),  for  retention  of  the  menses,  the 
chief  changes  were  a  diminution  in  size  and  tendency  to 
become  granular  at  the  margin  exhibited  by  the  red  disks 
(see  p.  192). 

According  to  Dr.  Beale,  in  leucorrhcea  "  many  imperfect 
cells  of  vaginal  epithelium  are  formed  upon  the  surface  of 
the  mucous  membrane,  as  well  as  pus  corpuscles.  Many 
pus  corpuscles  originate  in  the  cells  of  vaginal  epithelium 
(?),  even  after  the  cells  have  assumed  their  distinctive 
form  ;  but  many  of  the  younger  cells  of  vaginal  epithelium, 
and  those  in  the  follicles  of  the  mucous  membrane,  divide 
and  subdivide,  giving  rise  at  length  to  multitudes  of  the 
spherical  granular  cells  we  know  as  '  pus  corpuscles,' 
which  divide  and  subdivide  very  rapidly  if  freely  supplied 
with  nutrient  matter."  In  the  light  of  our  more  recent 
knowledge  in  regard  to  the  origin  of  pus,  however  (see  p. 
154),  we  are  now  obliged  to  modify  to  some  extent  these 
views,  expressed  by  the  distinguished  English  microscop- 
ist ;  considering  the  abundant  Leucocytes  not  as  abortive 
epithelium,  but  wandering  white  blood  corpuscles,  and 
their  relative  number  proportioned  to  the  amount  of  ob- 
struction to  the  blood-current  in  the  capillaries,  rather 
than  to  the  activity  of  any  proliferating  process. 

In  cases  of  suspected  cancer  of  the  womb  it  is,  as  a  rule, 
useless  to  expect  much  aid  to  diagnosis  from  any  examina- 
tion of  discharges  from  the  vulva,  since  the  cellular  ele- 
ments are  generally  too  much  disintegrated  for  recognition. 
-A  small  portion  of  the  secretion  from  the  os  uteri,  or  from 
the  ulcerated  surface  of  the  growth  itself,  should  such 
exist,  must  therefore  be  removed  by  means  of  a  probe  or 
pair  of  forceps  introduced  through  a  speculum,  and  on 
examination  with  a  power  of  200  diameters  will  probably 
disclose  at  least  a  few  cells  on  each  slide,  which  will  indi- 


ANAL,    VAGINAL,  AX  I)    UTERINE  DISCHARGES.      i>47 


with  more  or  less  certainty  the  character  of  the  morbid 
formation  (see  Chapter  XV.). 

The  lochial  discharges  consist,  in  their  early  stage, 
chiefly  of  red  blood  corpuscles,  Leucocytes,  and  epithelial 
cells  from  the  mucous  membrane  lining  the  uterine  cavity, 
either  isolated  or  in  flakes  of  aggregated  cells,  retaining 
their  normal  relations  to  each  other.  Later  in  the  puerperal 
month  the  first  of  these  ingredients  will  generally  have  dis- 
appeared, leaving  the  other  constituents  in  greater  or  less 
abundance,  according  as  the  discharge  approximates  on  the 
one  hand  to  the  thick,  yellow  secretion  of  leucorrhcea  or  on 
the  other  resumes  the  usual  characters  of  healthy  vaginal 
mucus.  Yon  Du'ben  states  that  the  white  (milky)  lochiaB 
contain  pus  in  abundance,  and  epithelium  in  the  process  of 
regeneration.  Exfoliation  of  the  epithelial  coats  of  both 
the  uterus  and  vagina  sometimes  occurs,  as  appears  from 
interesting  cases  reported  by  Dr.  Arthur  Farre  and  Dr. 
Tilt,  and  quoted  by  Prof.  Beale,  by  whom  the  membranes^ 
are  considered  to  correspond  in  structure  to  the  layers  of 
cuticle  detached  from  different  parts  of  the  cutaneous  sur- 
face after  scarlatina. 

I  have  several  times  been  able  to  discriminate  between 
mere  dysmenorrhoea  and  actual  abortion  by  careful  micro- 
scopic examination  of  a  few  fragments  of  such  portions  of 
the  clotted  blood  as  presented  a  loose,  sarcomatous  struc- 
ture, the  branching  tufts  of  the  villi  constituting  the  shaggy 
chorion  being,  if  present,  readily  recognized  under  a  power 
of  200  diameters.  As  the  management  of  cases  of  dys- 
menorrhcea  and  of  abortion,  both  at  the  time  of  and  subse- 
quently to  their  occurrence,  is  quite  different,  this  method 
may  sometimes  prove  an  important  aid  to  diagnosis  in 
doubtful  cases,  and  I  therefore  append  an  illustration  of 
the  appearance  of  the  placental  tufts,  drawn,  by  means  of 
the  camera  lucida,  from  a  recent  specimen.  (See  Fig.  24.) 

I  would  strongly  urge  upon  the  microscopist  the  im- 


248 


MEDICAL  MICROSCOPY. 


portance  of  studying  with  high  powers  the  pus  of  ulcers 
suspected  to  be  specific,  upon  either  the  male  or  female 
genitals,  as  the  few  observations  I  have  had  time  and 


Fia.  24. 


COMPOUND  VILLI  OF  THE  CHORION.    X  220  Diameters. 

opportunity  to  make  tend  strongly  to  confirm  the  opinion 
of  Donne  in  regard  to  the  immense  number  of  Vibrioneg 
occurring  in  chancrous  pus,  a  doctrine  which,  if  established, 
might  prove  of  great  value  in  the  diagnosis  of  syphilis  at 
its  earliest  stage. 

Dr.  J.  Marion  Sims,  so  well  known  as  for  many  years 
the  distinguished  surgeon  to  the  Woman's  Hospital,  New 
York,  a  comparatively  recent  proselyte  to  faith  in  the 
revelations  of  the  microscope  as  invaluable  aids  to  diag- 
nosis, has  signalized  his  conversion  by  certain  very  interest- 
ing applications  of  its  assistance  to  the  recognition  of  some 
of  the  different  causes  of  sterility.  In  his  Clinical  Notes 
on  Uterine  Surgery,  New  York,  1866,  Dr.  Sims  classifies 


ANAL,    VAGINAL,  AND    UTERINE  DISCHARGES.     249 

among  the  conditions  absolutely  necessary  for  conception, 
that  the  vagina  shall  be  capable  of  receiving  and  retaining 
the  spermatic  fluid ;  also,  that  semen  with  living  sperma- 
tozoa shall  be  deposited  in  the  vagina  at  the  proper  time ; 
and,  further,  that  the  secretions  of  the  cervix  and  vagina 
shall  not  poison  or  kill  the  spermatozoa.  As  the  presence 
or  absence  of  these  three  absolutely  indispensable  prelim- 
inaries to  fecundation  can  be  demonstrated  only  by  micro- 
scopic examination  of  the  spermatic  fluid  and  the  vaginal 
and  uterine  mucus,  it  becomes  obviously  a  matter  of 
importance  to  know  how  best  to  conduct  such  an  investi- 
gation, and  I  shall  therefore  give  Dr.  Sims's  own  directions, 
as  follows : — 

"  I  have  said  a  good  deal  about  semen  and  its  examina- 
tion, and  it  is  time  that  I  should  say  something  about  the 
measures  preliminary  to  this.  Suppose  we  wish  to  ex- 
amine the  vaginal  mucus  soon  after  coition, — say  within 
an  hour  ;  we  direct  the  patient  to  empty  the  bladder  just 
before  the  act,  and  to  retain  quietly  the  recumbent  posture 
after  it.  The  dorsal  decubitus  is  the  best.  To  remove  a 
few  drops  of  the  contents  of  the  vagina,  pass  the  index- 
finger  into  it,  press  the  posterior  wall  downwards  and 
backwards  just  under  the  cervix  uteri ;  hold  it  so  for  a 
minute  or  two;  the  semen  will  necessarily  gravitate  into 
the  pouch  made  by  this  pressure;  then  introduce  the 
nozzle  of  the  syringe  along  the  finger  ;  let  it  project  slightly 
over  the  end  of  the  finger-nail,  and  it  will  be  easy  enough 
to  obtain  what  we  want,  if  there  is  any  semen  in  the  vagina. 
I  am  thus  minute  in  explaining  this  simple  operation,  be- 
cause we  may  fail  in  it  entirely,  even  when  the  vagina 
contains  large  quantities  of  semen,  if  we  neglect  these 
minutiae.  And  in  this  way.  If  we  pass  the  syringe  in  a 
hap-hazard  manner,  and  begin  to  draw  the  piston,  the 
mucous  membrane  of  the  vagina  is  sucked  up  into  the  end 
of  the  tube,  and  thus  it  is  possible  for  us  to  slide  it  around 

22 


250  MEDICAL  MICROSCOPY. 

in  various  directions  without  getting  a  drop  of  mucus  of 
any  sort.  But  suppose  we  fail  even  with  properly  directly 
(directed)  efforts?  Then  the  left  lateral  position  and  my 
speculum  will  in  a  moment  show  us  the  whole  of  the  con- 
tents of  the  vagina,  and  we  can  with  the  syringe  remove 
what  we  want.  When  we  wish  to  examine  the  cervical 
mucus,  we  should  resort  at  once  to  the  speculum  and  the 
proper  position.  It  is  well  enough  then  to  sponge  away 
all  the  mucus  from  the  vagina,  and  especially  from  about 
the  cervix  uteri.  We  then  pass  the  nozzle  of  the  syringe 
just  within  the  os  tineas  and  draw  up  a  drop  of  its  mucus. 
To  do  this  it  is  necessary  first  to  pull  the  cervix  forward, 
so  as  to  look  into  it  to  see  exactly  what  we  are  doing.  If 
the  cervical  mucus  is  very  tenacious,  we  may  fail  to  get  it 
away.  Then  it  will  at  the  next  attempt  be  necessary, 
after  introducing  the  syringe  and  drawing  up  the  mucus, 
to  pass  the  left  index-finger  to  the  edge  of  the  os  tinea?, 
and  slide  the  end  of  the  syringe  on  to  the  end  of  the 
finger,  without  raising  it  from  the  surface  of  the  cervix  or 
breaking  its  suction-power.  This  may  seem  to  be  a  little 
thing  to  describe  so  minutely,  but  really  it  is  a  most  im- 
portant matter  to  do  if  we  expect  to  be  exact  in  our  inves- 
tigations. The  nicety  of  this  manipulation  renders  it  the 
more  important  for  us  to  clear  away  all  the  vaginal  mucus 
before  we  undertake  it,  lest  we  get  some  of  this  drawn  up 
into  the  syringe,  which  would  of  course  mar  the  precision 
of  our  observations.  Suppose  we  succeed  in  this,  then 
we  may  wish  to  pass  the  syringe  up  for  an  inch  into  the 
cervix,  to  get  a  portion  of  mucus  nearer  the  cavity  of  the 
uterus.  This  operation  is  quite  as  delicate  and  quite  as 
important  as  the  first,  and  is  to  be  conducted  in  the  same 
way." 

As  an  illustration  of  his  method  of  investigation,  Dr. 
Sims  relates  the  case  of  a  lady  who,  although  apparently 
quite  healthy,  had  been  married  eight  years  without  off- 


ANA L,    VAGINAL,  AND    UTERINE  DISCHARGES.      251 

spring-.  "  The  questions  to  be  answered  were,  Was  the 
semen  normal  ?  Did  the  secretions  of  the  vagina  or  cervix 
poison  the  spermatozoa  ?  Did  these  enter  the  canal  of  the 
cervix  ?  The  vagina  was  examined  an  hour  after  sexual 
intercourse.  Its  mucus  contained  living  spermatozoa  in 
abundance.  The  cervical  mucus  was  full  of  them,  but 
they  were  all  dead.  On  another  occasion  a  microscopic 
examination,  made  a  few  minutes  (eight  or  ten)  after 
coition,  proved  that  the  mucus  of  the  cervical  canal  was 
full  of  dead  spermatozoa,  while  in  the  vagina  they  were 
living.  Here  the  litmus  test  (for  acidity)  was  valueless, 
but  the  microscope  demonstrated  a  superabundance  of 
epithelial  casts,  the  result  of  a  slightly  congested  condi- 
tion of  some  portion  of  the  lining  membrane  of  the 
cervix." 

Such  observations  as  those  above  detailed  may  appear 
trifling,  or  even  wanting  in  propriety,  to  the  uninitiated,  but 
the  true  votary  of  science,  who  recognizes  the  fact  that 
just  as  in  the  macrocosm  nothing  is  so  vast  that  its  inves- 
tigation is  utterly  beyond  the  bounds  of  human  intellect, 
so  in  the  microcosm  nothing  is  too  minute  to  be  beneath 
the  power  or  unworthy  the  exercise  of. human  research, 
must  ever  feel  grateful  for  such  contributions  to  our  stock 
of  positive  knowledge,  not  only  as  being  valuable  in  them- 
selves, but  on  account  of  their  usefulness,  or  at  least  im- 
portance, to  the  race.  Who  shall  say,  indeed,  especially 
in  view  of  the  history  of  France  under  her  great  First 
Consul,  that  some  fortunate  Old-World  gynecologist, 
simply  by  changing  the  reaction  of  the  cervical  mucus  in 
an  unprolific  queen  from  slightly  acid  to  barely  alkaline 
by  means  of  a  grain  or  so  of  carbonate  of  soda,  may  not 
preserve  the  life  of  a  royal  spermatozoon,  and  thereby 
insure  (revolutions  permitting)  the  perpetuation  of  a 
dynasty  of  kings  ? 


CHAPTER   XIII. 

EXAMINATION  OF  THE  INTEGUMENT  AND   MUSCLES  FOR  THE 
DETECTION    OF    ANIMAL   AND    VEGETABLE    PARASITES. 

ALTHOUGH  one  great  English  authority  upon  cutaneous 
maladies,  with  a  negative  determination  which,  when  of 
an  opposite  character,  constitutes  the  praiseworthy  quality 
of  perseverance,  still  refuses  to  admit  the  existence  of  the 
dermatophytic  affections,  yet  the  weight  of  evidence  in 
favor  of  this  class  of  skin  diseases  is  so  strong  that  I  can 
feel  no  hesitation  in  arranging  it  with  the  dermatozoa. 
Indeed,  we  see  to-day,  in  regard  to  Favus,  the  same  old 
battle  fought  again  which,  fifty  years  ago,  was  so  strenu- 
ously contested  by  Biett  and  Morgagni  on  the  one  hand, 
and  the  microscopists  on  the  other,  in  relation  to  Scabies, 
now  universally  admitted  to  be  due  to  a  minute  insect,  the 
Acarus  Scabiei ;  and  to  the  student  of  human  nature  it  is 
a  most  interesting  confirmation  of  the  wise  king's  dictum, 
"there  is  no  new  thing  under  the  sun,"  to  observe  how  the 
same  doubts,  followed  by  the  same  objections,  were  urged 
against  the  parasitic  character  of  the  itch,  that  are  now 
put  forward  in  opposition  to  the  vegetable  nature  of 
Ringworm  or  Favus.  Thus,  Biett,  Cazenaze,  Lugol,  etc. 
denied  that  even  with  the  aid  of  microscopes  of  high 
power  any  insect  whatever  could  be  discovered.  When, 
by  a  succession  of  lucky  accidents,  so  many  observers  blun- 
dered into  seeing  the  acarus  that  this  position  was  no 
longer  tenable,  opponents  to  the  parasitic  theory  changed 
their  base  of  operations,  and,  admitting  the  occasional  ex- 


/:.!   I  MIRATION  OF  INTEGUMENT  AND  MUSCLES.      253 

istence  of  the  insect,  stoutly  maintained  that,  instead  of 
being  the  cause  of  Scabies,  it  was  a  "  secretory  product"  of 
that  affection,  and  by  no  means  a  constant  one.  Finally, 
when  the  proof  that  the  whole  disease  could  arise  from  the 
deposit  of  a  single  itch  insect  upon  the  skin  of  a  previously 
healthy  person  became  incontestable,  the  anti-microscop- 
ists  took  refuge  in  the  assertion  that  in  such  cases  "  the 
insect  taken  from  the  scabious  vesicle,  being  charged  with 
the  virus,  the  fluid  of  the  vesicle,  by  penetration  of  the 
cuticle,  inserted  this  virus  and  produced  the  disease,  like 
the  inoculation  of  cow-pox." 

In  some  sections  of  our  country,  where  Scabies  is  of  fre- 
quent occurrence,  it  becomes  a  matter  of  real  importance 
that  the  practitioner  should  be  able  to  diagnosticate  the 
affection  from  other  skin  diseases  promptly  and  certainly  ; 
because,  if  he  do  not,  some  old  woman  among  his  clientele 
will  in  the  course  of  time  happen  to  be  right  for  once 
when  he  is  wrong,  which  isolated  fact,  being  industriously 
circulated  by  the  local  Mrs.  Grundy,  will  result  very  detri- 
mentally to  his  practice,  and  probably  cost  him  more  in 
the  end  than  a  good  microscope  would  do.  Some  years 
ago  I  was  fortunate  enough  to  decide  a  case  of  this  kind, 
near  my  late  residence  in  Western  New  York,  very  satis- 
factorily, as  follows:  A  little  girl,  about  five  years  old, 
was  refused  admission  into  a  large  school,  for  fear  that  an 
eruption  upon  her  neck  and  arms  might  be  communicated 
to  other  scholars,  as  it  was  suspected  to  be  the  itch,  an 
imputation  which  the  child's  family,  people  of  village 
consequence,  resented  with  considerable  asperity.  On 
the  girl  being  brought  to  me  for  a  decision  in  regard  to 
the  nature  of  her  disease,  I  soon  succeeded  in  extracting 
from  her  skin  a  full-grown  female  of  the  Acarus  Scabiei, 
which,  when  placed  beneath  the  microscope,  showed  a 
specimen  of  animal  life  in  high  activity.  This  I  exhibited 
to  the  child's  relations  and  to  the  principal  of  the  school, 

22* 


254  MEDICAL  MICROSCOPY. 

none  of  whom,  after  comparing  it  with  drawings  of  the 
insect  and  seeing  it  crawl  upon  the  glass  slide,  could  doubt 
that  the  veritable  "  Itch-bug"  stood  before  them. 

When  consulted  by  a  patient  in  regard  to  cutaneous 
disease,  the  great  symptom  which  as  a  general  rule 
should  lead  us  to  suspect  Scabies  is  the  appearance  of  a 
vesicular  or  pustular  eruption  between  the  roots  of  the 
fingers  and  at  the  bend  of  the  wrists  and  the  elbows, — the 
itch  occurring  in  these  situations  at  least  nineteen  times 
out  of  every  twenty  ;  and  if  on  further  inquiry  we  find  that 
a  somewhat  similar  eruption  occupies  the  belly,  the  inner 
part  of  the  thighs,  and  the  flexor  surfaces  of  the  knees,  and 
that  the  itching  becomes  almost  intolerable  at  night,  we 
may  feel  a  high  degree  of  confidence  that,  our  patient  is 
inhabited  by  the  Acarus  Scabiei.  In  searching  for  the 
insect,  I  would  advise  the  microscopist,  should  he  have  a 
choice  of  cases,  to  select  that  of  a  child  under  ten  years 
old,  preferably  a  girl,  and  carefully  examine  in  a  strong 
light  the  folds  of  skin  between  the  fingers  and  upon  the 
volar  surfaces  of  the  wrists  (as  a  matter  of  personal  pre- 
caution requiring  all  suspected  patients  to  present  them- 
selves during  the  day,  when  the  Acarus,  being  a  nocturnal 
insect,  is  not  likely  to  wander  off  upon  the  hands  of  the 
physician).  Should  these  portions  of  the  body  have  been 
badly  scratched  by  the  nails,  his  investigation  may  fail ; 
but  in  favorable  examples  of  the  affection  he  will  soon 
find  among  numerous  ordinary-looking  vesicles,  papules, 
and  pustules,  more  or  less  irritated  by  scratching,  two  or 
three  inflamed  points,  each  of  which  has  running  from 
its  circumference  a  whitish  line  from  a  quarter  to  half 
an  inch  long,  either  straight  or  curved  into  a  semicircle. 
One  of  these  being  selected,  which,  when  closely  scruti- 
nized either  with  the  naked  eye  or  a  hand  magnifying 
glass,  seems  to  be  a  little  thicker  and  more  opaque,  so  as 
to  appear  club-shaped  at  its  outer  extremity,  it  is  to  be 


EXAMINATION  OF  INTEGUMENT  AND  MUSCLES.     255 

very  carefully  slit  up  with  a  delicate  knife  or  cataract- 
needle  to  its  termination,  care  being  taken  not  to  press  on. 
the  contents  of  the  line  or  furrow  with  the  back  of  the 
needje,  which  is  then  to  be  placed  under  the  little  swelling 
at  the  extremity  of  the  furrow,  the  minute  particle  of  matter 
which  constitutes  it  gently  lifted  out  and  transferred  to 
the  stage  of  the  microscope,  when  it  will  probably  be 
found  to  present  the  characters  of  the  itch  insect.     To  the 
naked  eye,  this  parasite  is  about  the  size  of  a  grain  of 
ordinary  writing-sand  and  yellowish-white  in  color ;  it  is 
often  so  active  that  if  placed  upon  a  piece  of  glass  laid 
over  some  dark  surface,  by  a  fiber  of  white  thread  (as  a 
point  of  departure)  its  motion  can  be  readily  detected 
without  a  lens.     When  magnified,  it  is  seen  to  be  oval, 
like  a  tortoise,  in  shape,  and  at  maturity  provided  with 
eight  legs  studded  with  hairs,  some  nearly  half  the  length 
of  its  body.     If  a  first  attempt  to  find  the  insect  proves 
unsuccessful,  other  furrows  (technically  called  cuniculi) 
should  be  investigated   in   a   similar   manner,   until   the 
sought-for  discovery  is  made.     In  case   no   burrows  or 
cuniculi  are  visible,  some  of  the  vesicles  which  appear  to 
have  been  least  disturbed  by  scratching  may  be  slit  open, 
the  fluid  removed,  the  cavity  scraped  out  with  the  point 
of  a  knife,  and  the  whole  transferred  to  a  slide  for  exami- 
nation, taking  great  care  not  to  crush  any  of  the  tiny  par- 
ticles, which  may  be  acari,  in  the  process  of  removing  them 
from  the  instrument.    In  cases  of  Scabies  complicated  with 
Eczema,  where  both  cuniculi  and  vesicles  are  apt  to  be 
obscured  by  the  crusts  of  the  latter  affection,  the  diagnosis 
may  often  be  much  aided  by  an  examination  of  the  crusts 
themselves,  as  recommended  by  Dr.  C.  Hilton  Fagge  in 
the  Lancet  for  April  4,  1868.     Pieces  of  the  eczematous 
crusts  from  a  suspected  case,  which  would  form  a  mass 
about  as  large  as  the  last  joint  of  the  forefinger,  are  to  be 
boiled  in  an  ounce  of  solution  of  caustic  soda  (see  page  38) 


256  MEDICAL  MICROSCOPY. 

until  they  are  in  great  part  dissolved.  The  flocculent 
material  is  then  allowed  to  subside,  the  supernatant  fluid 
poured  off,  and  the  deposit  examined  under  the  microscope. 
In  it  may  frequently  be  detected  full-grown  male  acari, 
the  young  in  various  stages  of  development,  eggs,  egg- 
shells, and  the  debris  of  all  these,  any  of  which,  when 
they  occur,  of  course  decide  the  nature  of  the  complaint. 
In  regard  to  some  mild  cases  of  this  malady,  Dr.  M'Call 
Anderson  remarks :  "It  occasionally  happens  that  Scabies 
exists  to  a  very  trifling  extent,  and  either  gives  rise  to  no 
itching,  or  at  least  the  patient  says  his  skin  is  not  itchy. 
Then,  of  course,  there  being  no  itching,  there  is  no  scratch- 
ing, and  there  is  a  total  absence  of  secondary  eruptions. 
It  may  fairly  be  asked  how  such  patients  ever  come 
under  the  notice  of  the  physician,  seeing  that  they  com- 
plain of  nothing;  to  which  it  must  be  answered  that 
they  often  come  to,  or  are  sent  for  by,  the  physician  in 
consequence  of  their  sleeping  in  the  same  bed  as  a  patient 
who  manifestly  has,  or  who  is  suspected  of  having,  the 
disease,  or  for  some  such  reason.  In  these  cases  we  are 
sometimes  able  to  say  that  Scabies  is  present,  owing  to 
the  detection  of  a  single  typical  cuniculus,  from  which  the 
female  acarus  may  be  extracted." 

It  will  probably  be  often  a  matter  of  surprise,  on  first 
examining  cases  of  Scabies,  to  find  what  a  great  amount 
of  secondary  irritation  may  be  set  up  in  other  portions  of 
the  body  by  the  burrowing  of  the  female  insects  and  the 
scratching  of  the  patients  themselves.  Thus,  Dr.  Ander- 
son observes:  "The  appearances  which  the  skin  presents 
in  cases  of  Scabies  are  due  to  two  causes, — first,  to  the 
irritation  of  the  acari,  and  second,  to  the  scratching  to 
which  the  patient  is  driven  by  the  irritation.  The  former 
are  often  scanty  and  undefined,  and  require  to  be  carefully 
searched  for ;  the  latter  are  usually  the  most  striking  feat- 
ures of  the  disease.  The  most  common  form  of  eruption 


/•:.r .1  MIX AWON  OF  INTEGUMENT  AND  MUSCLES.    257 

induced  by  the  scratching  is  termed  a  pruriginous  erup- 
tion, because  it  resembles  so  closely  the  phenomena  of  the 
disease  termed  prurigo ;  that  is  to  say,  the  orifices  of  the 
follicles  become  prominent,  their  summits  are  torn  by  the 
nails  of  the  patient,  and  the  blood  which  is  thus  drawn 
dries  up;  forming  little  black  spots  on  the  top  of  the  papu- 
lae. This  pruriginous  eruption  is  met  with  in  all  parts  of 
the  body,  but  in  typical  cases  it  is  decidedly  most  marked 
upon  the  lower  aspect  of  the  abdomen,  the  inner  aspect  of 
the  thighs  and  the  forearms,  while  the  upper  arms,  upper 
half  of  the  trunk,  and  the  legs  are  comparatively  free.  In 
a  great  many  cases  pustules  are  similarly  induced,  and 
these  are  usually  of  large  size  (ecthymatous  pustules,  as 
they  are  termed)  ;  when  this  is  the  case,  the  complaint  is 
commonly  spoken  of  as  Scabies  purulenta.  They  are  almost 
uniformly  present  in  severe  cases  in  children,  whose  skins 
are  delicate,  on  the  hands,  feet,  and  hips ;  so  much  so  that 
pustules  in  such  situations  are  almost  pathognomonic  of 
Scabies,  probably  occurring  upon  the  hips  of  infants  from 
the  infection  conveyed  by  the  hands  of  nurses  carrying 
them.  Again,  when  persons  with  a  constitutional  tendency 
to  eczema  are  attacked  by  the  acarus,  an  eczematous  erup- 
tion is  apt  to  be  called  forth  by  the  irritation,  which  may 
assume  any  of  the  varied  forms  of  eczema,  and  which  pre- 
sents exactly  the  same  appearances  as  an  eczema  called 
forth  by  other  causes." 

The  treatment  of  Scabies  should  be  directed  to  the 
destruction  of  the  insects,  and  to  the  removal  of  the  erup- 
tions excited  by  their  presence  and  the  consequent  scratch- 
ing ;  when  the  latter  are  very  severe,  it  may  be  necessary 
first  to  allay  their  irritation  by  cold  sedative  applications, 
such  as  slippery-elm  mucilage,  or  Goulard's  Extract  of 
Lead,  before  applying  any  of  the  ointments  for  killing  the 
parasite,  which  are  generally,  either  in  themselves  or  in 
their  mode  of  application,  more  or  less  irritating. 


258  MEDICAL   MICROSCOPY. 

The  most  effectual  remedy  for  Scabies  is  sulphur,  and  in 
my  hands  has  been  almost  uniformly  successful  when 
faithfully  employed  in  the  following  combination: 

R. — Potassae  Carbonatis  (sal  tartar),  giij  ; 
Sulphur.  Sub.  gvj  ; 
Adipis,  giv. 

S. — Hub  in  well  over  the  whole  body  (or  as  much  as  is  affected), 
for  fifteen  minutes  every  night  at  bedtime,  for  three  nights  in  suc- 
cession. 

The  objections  to  such  an  ointment  in  this  disease  are  its 
irritating  effects  upon  the  secondary  eruptions,  and  its  dis- 
gusting odor;  to  obviate  the  former  of  these  disadvantages, 
Hebra  recommends  the  following : 

R. — Sulphuris  precipitati, 
Picis  liquida,  aa  £vj  ; 
Saponis  Viridis  (soft  soap), 
Adipis,  aa  Ibj  ; 
Cretae,  ^iv. 
Misce. 

Dr.  JVTCall  Anderson  greatly  prefers  for  private  practice 
the  following : 

R. — Styracis  liquidi,  |jj  ; 

Adipis,  gij. 
Melt  and  strain. 

This,  he  states,  is  "a  clean-looking  ointment,  it  has  a 
pleasant  aroma,  it  kills  the  acari,  and  it  does  not  irritate 
the  skin  in  the  least,  but,  on  the  contrary,  rather  soothes  it." 

The  rare  form  of  this  disease  called  Scabies  Norvegica, 
far  more  serious  than  the  ordinary  complaint,  is  only  an 
exaggerated  condition  or  more  advanced  stage,  due  to  the 
same  acarus,  in  people  who  are  extremely  dirty ;  it  is  so 
much  more  severe  that  cases  are  reported  which  proved 
fatal,  from  secondary  affections. 

The  sebaceous  follicles  of  the  face,  and  the  ceruminous 
glands  of  the  ear,  are  often  the  home  of  another  parasite, 
the  Acarus  folliculorum,  specimens  of  which  are  to  be  found 


EXAMINATION  OF  INTEGUMENT  AND  MUSCLES,      259 

in  most  persons  more  or  less  abundantly ;  they  feed  only 
on  the  sebaceous  matter  of  the  follicles,  and  do  not  of  thrm- 
selves  give  rise  to  any  disease,  as  far  as  we  know  at  present. 
To  obtain  them  as  microscopic  objects,  it  is  merely  neces- 
sary to  squeeze  out  the  secretion  from  a  few  of  the  glands 
upon  a  slide,  and  break  it  up,  with  a  fine  mounted  needle^ 
in  a  drop  of  sweet  oil,  when  the  insects  may  generally  be 
seen  on  examination  with  a  power  of  about  200  diameters. 
One  of  the  most  important  among  the  microscopic  en- 
tozoa  is  the  Trichina  spiralis,  a  -parasite  whose  frequency 
and  fatality  to  human  life  have  of  late  years  attracted  much 
attention,  especially  since  numerous  cases  of  obscure  com- 
plaints ending  in  death  have  been  traced  to  this  cause  on 
post-mortem  examination.  The  Trichina  appears  to  have 
been  first  discovered  by  James  Paget,  in  1835,  and  was 
described  and  named  by  Professor  Owen  from  specimens 
obtained  from  Paget's  case.  Leuckart,  Yirchow,  Leidy, 
Kiichenmeister,  and  many  others,  by  their  observations 
and  experiments,  added  to  our  knowledge  of  this  parasite ; 
but  it  was  not  until  Zenker,  of  Dresden,  in  January,  1860, 
traced  the  connection  between  the  eating  of  ham  and 
sausages  "  filled  with  vast  numbers  of  trichinae,"  and  the 
development  of  a  fatal  disease  presenting  most  of  the 
symptoms  of  typhoid  fever,  but  depending  upon  the  pres- 
ence of  innumerable  entozoa,  that  we  became  acquainted 
with  this  terrible  and  previously  unknown  source  of 
disease.  Since  that  time,  however,  a  great  number  of 
cases  has  been  reported,  occurring  in  almost  all  parts  of 
the  civilized  world,  but  especially  in  Germany,  where  we 
are  informed  by  Dr.  Jackson  (Amer.  Jour.  Med.  Sciences, 
January,  1867)  that  more  than  two  thousand  cases  of 
trichinous  infection  have  been  published  ;  this  large  pro- 
portion of  the  whole  number  of  instances  being  no  doubt 
attributable  to  the  Teutonic  custom  of  partaking^  of  un- 
cooked pork  and  other  kinds  of  flesh,  in  the  form  of  raw 
sausage,  etc. 


260  MEDICAL  MICROSCOPY. 

According  to  Rupprecht,  the  first  period  of  Trichiniasis, 
that  of  gastro-intestinal  irritation,  comprises  the  first  week 
or  ten  days  of  the  affection.  The  severity  of  its  symptoms 
depends  upon  the  amount  of  infected  food  ingested,  and  the 
rapidity  with  which  the  cysts  inclosing  the  worms  are  dis- 
solved. The  first  onset  generally  occurs  within  forty-eight 
hours  after  the  parasites  enter  the  system,  and  is  charac- 
terized in  severe  cases  by  vomiting,  diarrhoea,  and  violent 
colic,  not,  however,  distinguishable  from  those  presented 
by  gastro-intestinal  irritation  from  other  causes.  The  second 
period,  that  of  muscular  irritation,  is  generally  ushered  in 
by  oedema  of  the  eyelids  and  face,  which,  though  occa- 
sionally absent,  frequently  appears  about  the  end  of  the 
first  week,  accompanied  by  chemosis,  mydriasis,  and  a 
feeling  of  tension  in  the  frontal  region  and  across  the  root 
of  the  nose.  Dr.  E.  R.  Hun,  of  Albany,  N.Y.,  mentions 
that,  in  cases  observed  by  him,  "about  the  end  of  the 
second  week  a  peculiarity  developed  itself  in  the  gait  of 
the  patient,  who  walked  upon  his  toes,  as  if  unable  to  rest 
his  heels  upon  the  floor."  Of  the  constitutional  symp- 
toms, the  febrile  movement  is  the  most  obvious,  the  pulse 
ranging  up  to  one  hundred  and  twenty  per  minute,  with  a 
temperature  of  104°  to  106°  Fahr.,  although  the  skin  is 
often  moist,  and  sometimes  bathed  in  profuse  perspiration 
or  covered  with  sudamina.  This  excessive  sweating  is 
attributed  to  excitement  of  the  sudoriparous  glands  from 
congestion  resulting  mechanically  from  the  presence  of  the 
parasites  in  the  subjacent  muscles.  A  tetanic  rigidity  and 
tendency  to  contraction  of  most  of  the  muscles  develop 
themselves  toward  the  close  of  the  second  week,  rendering 
the  muscular  tissue  swollen,  hard,  and  painful.  The  patients 
are  said  generally  to  lie  during  most  of  this  period,  which 
continues  for  three  or  four  weeks,  upon  the  back,  unable  to 
move,  and  in  great  suffering.  In  the  fourth  or  fifth  week, 
when  the  muscles  concerned  in  respiration  become  in- 


/  :.V  AM  [NATION  OF  INTEGUMENT  AND  MUSCLES.     261 

volved,  partial  paralysis  may  come  on,  terminating  fatally, 
or  death  may  occur,  with  typhoid  symptoms. 

The  third  period,  or  that  of  convalescence,  in  more 
favorable  cases,  is  entered  upon  during  the  fifth  week, 
bring  ushered  ill  by  a  diminution  of  the  febrile  symptoms. 
The  appetite,  however,  returns  slowly  ;  prostration  is  very 
marked,  ami  oedema  of  the  limbs,  or  even  general  dropsy, 
apparently  from  anaemia,  frequently  manifests  itself.  Oc- 
casionally the  hair  and  nails  fall  off,  and  desquamation  of 
the  skin  may  occur. 

If,  then,  we  are  called  upon  to  investigate  a  case  of 
disease  resembling  typhoid  fever  or  acute  rheumatism, 
which  in  the  course  of  the  second  week  presents  the 
peculiar  oedema  of  the  eyelids  and  face  above  referred  to, 
our  attention,  if  not  earlier  directed  towards  Trichiniasis, 
should  be  at  once  awakened  to  the  possibility  of  its  exist- 
ence, and  a  most  thorough  and  careful  inquiry  in  regard  to 
the  chance  of  infection  by  partaking  of  diseased  meat,  even 
if  supposed  to  be  well  cooked,  should  be  made.  In  case 
ground  for  suspicion  in  respect  to  any  contamination  of  meat 
used  as  food  appears,  portions  of  it,  if  accessible,  should 
be  rigidly  examined  microscopically ;  while,  to  confirm  the 
diagnosis,  or  should  other  means  of  reaching  it  fail,  small 
portions  of  some  of  the  patient's  voluntary  muscles,  such, 
for  example,  as  the  deltoid  or  biceps,  should  be  extracted 
for  investigation,  by  making  an  incision  through  the  in- 
tegument and  adipose  tissue,  after  the  employment  of  Dr. 
B.  W.  Richardson's  local  anaesthesia  by  ether  spray,  and 
picking  up  a  few  fibers  with  forceps,  or,  preferably,  by 
means  of  instruments  resembling  harpoons  in  miniature, 
furnished  by  dealers-  for  the  purpose.  (See  paper  by  Dr. 
W.  W.  Keen,  Am.  Jour.  Med.  Set,  October,  1869,  page  431.) 

Dr.  Jackson,  in  his  paper  quoted  above,  gives  the  follow- 
ing description,  condensed  from  various  Continental  author- 
ities: "  The  trichina  is  from  Omm  -15  to  3  millimetres 

23 


262 


MEDICAL  MICROSCOPY. 


FIG.  25. 


TRICHINA  SPIRALIS,  WITH  CAPSULE, 
FROM  HUMAN  SUBJECT.  (After  Beale.) 
X  40  Diameters. 


(T^  to  i  of  an  incn)  in  length  and  from  Omm  -03  to  Omm 
'°5  (BITTF  to  -fro  °f  an  inch)  in  thickness.  (Dalton  gives 
the  length  -^  of  an  inch,  breadth  -j-i^  of  an  inch.) 

"  When  in  the  larval  or  encysted  state,  it  is  asexual ;  but 

on  being  taken  into  the  stom- 
ach it  undergoes  full  de- 
velopment, the  female  being 
of  greater  length  than  the 
male,  and  always  being  found 
in  proportion  to  the  latter  in 
much  greater  numbers,  by 
some  observers  it  having  been 
seen  to  be  seven  or  eight 
times  as  numerous.  Besides 
an  alimentary  canal,  the  fe- 
male has  an  additional  tube, 
opening  towards  the  mouth, 
which  latter  is  situated  at  the 
most  attenuated  end  of  the  worm,  contrary  to  what  the 
early  observers  supposed.  This  tube  is  the  receptacle  for 
its  eggs  (sic),  which  are  developed  within  her  previous  to 
extrusion ;  the  animal  is  consequently  viviparous,  and 
produces,  according  to  Yirchow,  200,  Gerlach,  400,  and, 
according  to  Leuckart,  1000  embryos.  The  young  thus 
born,  as  stated  above,  are  without  sex.  It  would  seem 
that  reingestion  by  the  stomach  or  bowels  is  necessary  to 
their  development ;  for  if  they  remain  in  their  encysted 
state  they  ultimately  perish.  Immense  numbers  of  them 
maybe  found  within  a  very  small  space.  Dalton  observed 
twelve  trichinae  in  a  piece  of  muscle  the  one-twelfth  of  an 
inch  square  and  one-fiftieth  of  an  inch  thick, — which  would 
give  7200  to  the  square  inch  ;  and  we  ourselves  have,  in  a 
piece  of  muscle  weighing  one-tenth  of  a  grain,  been  able  to 
distinctly  count  11,  giving  thus  52,800  to  the  ounce  ;  a  few 
mouthfuls  of  food  infested  at  such  a  rate  would  afford 
females  enough  to  generate  millions." 


r.X  AM  [NATION  OF  INTEGUMENT  AND  MUSCLES.     263 

"  The  parent  trichinae,  after  giving  birth  to  their  young, 
are  expelled  from  the  intestines;  about  a  week  usually 
after  trichinous  food  has  been  taken  into  the  stomach,  the 
young  animals  have  been  hatched  and  commence  boring 
into  the  walls  of  the  intestines,  though  Fiedler's  experi- 
ments upon  rabbits  show  that  the  trichinae  may  become 
sexual  during  the  second  or  third  day,  and  the  embryos 
quit  the  mother  to  commence  their  peregrinations  on  the 
fourth  day.  They  seek  the  striated  muscles  as  their 
destination." 

"A  number  of  observers  have  supposed  that  the  young 
worms  reach  their  ultimate  habitat  by  the  torrent  of  the 
circulation.  Dr.  Dalton  expresses  himself  as  of  that 
opinion,  and  in  some  observations  was  led  to  conclude 
that  the  cysts  were  formed  within  the  walls  of  the  capil- 
laries. He  thinks  the  oedema  of  trichiniasis  lends  con- 
firmation to  his  observation,  which  he  says  it  would  be 
difficult  to  explain  on  any  other  supposition,  but  is  easily 
understood  by  an  arrest  of  the  circulation  taking  place 
simultaneously  in  so  many  capillary  blood-vessels  as  must 
necessarily  be  obstructed  when  7000  trichinae  are  con- 
tained within  the  space  of  a  cubic  inch." 

Virchow,  Leuckart,  and  many  others,  however,  assert 
that  the  parasite  passes  from  the  intestines  to  the  volun- 
tary muscles  solely  by  vermicular  motion.  All  the  striated 
muscles,  except  the  heart,  furnish  them  a  nidus ;  but  they 
have  not  been  found  in  the  brain,  liver,  kidneys,  or  to  any 
extent  in  adipose  tissue.  After  encapsulation  they  give 
rise  to  no  further  trouble  ;  the  cysts,  which  usually  contain 
but  a  single  worm,  become  thickened  and  hardened,  and 
finally  undergo  calcareous  degeneration,  in  which  state 
they  may  preserve  living  trichinae  for  at  least  twenty-four 
years.  (London  Med.  Times  and  Gazette,  June,  1866.) 
The  wonderful  tenacity  of  life  displayed  by  encysted  mus- 
cular trichinae  is  such  that  Leuckart  submitted  trichinous 


264  MEDICAL  MICROSCOPY. 

flesh  to  a  temperature  of  — 13°  Fahrenheit  for  three  days 
without  injuring  them.  Hertwig  "  boiled  trichinous  meat, 
cut  in  slices  the  size  of  one's  thumb,  for  twenty-two  minutes 
without  killing-  the  trichina,  though  a  continuation  of  the 
boiling  three  minutes  longer  destroyed  them."  Yirchow 
showed  by  experiment  that  they  endured  the  action  of 
chromic  acid  for  eight  days  without  injury;  and  accurate 
observations  demonstrate  that  persons  may  be  infected  by 
pork  which  has  been  thoroughly  smoked  and  salted.  The 
only  safeguard,  therefore,  against  Trichiniasis  is  to  subject 
all  meat  used  as  food  for  at  least  half  an  hour  to  a  tem- 
perature above  170°  Fahrenheit;  at  which  point  the  albu- 
men in  the  tissues  of  any  entozoa  it  may  contain  will 
become  coagulated,  and  the  death  of  the  parasite  be  insured. 
According  to  the  very  interesting  observations  of  Dr.  J. 
Stockton  Hough,  late  resident  physician  to  the  Philadel- 
phia Hospital,  Blockley,  it  seems  probable  that  Trichiniasis 
does  exist  in  numerous  instances  in  our  own  country,  with- 
out being  suspected ;  he  reporting  four  cases  discovered  in 
the  wards  of  the  Philadelphia  Hospital,  the  first  of  which 
he  recognized,  almost  by  accident,  after  death.  This  first 
patient  was  an  Irishwoman,  aged  28,  who  died  of  phthisis, 
January  16,  1869.  (Am.  Jour,  of  Mecl.  Sciences,  April, 
1869,  p.  565.)  "At  the  post-mortem  examination,"  he  ob- 
serves, "on  opening  the  chest  my  attention  was  attracted 
to  a  condition  of  the  pectoral  muscles  which  seemed  to  be 
abnormal.  On  closer  examination,  calcareous  points  were 
noticed  in  them,  but,  observing  that  they  \\^ere  symmetrical 
in  form,  and  all  of  about  the  same  size,  I  concluded  that 
they  must  be  organized.  The  cysts,  on  being  subjected  to 
microscopical  examination,  were  found  to  be  lemon-shaped 
and  opaque.  On  breaking  one  open  I  found  a  Trichina 
spiralis.  These  cysts  are  from  ^  to  ^  of  an  inch  long, 
with  a  transverse  diameter  about  half  as  great  as  the 
length,  and  firm  from  calcareous  degeneration.  By  treat- 


EXAMINATION  OF  INTEGUMENT  AND  MUSCLES.      265 

ing  the  opaque  cyst  with  a  drop  of  dilute  chlorohydric  acid 
the  carbonate  of  lime  is  decomposed,  and  the  larval  trichina 
is  seen  coiled  up  in  various  styles.  The  larval  trichina  is 
about  -^g  of  an  inch  long  by  about  7^j-  of  an  inch  in  trans- 
verse diameter.  Some  cysts  contained  two  worms ;  all 
were  encysted.  The  cadaver  measured  five  feet  two  inches 
in  length,  and  weighed  sixty  pounds.  The  muscle  alone 
is  estimated  to  weigh  twenty-four  pounds.  From  these 
data,  counting  the  number  in  one  grain  of  muscle,  the 
whole  number  of  cysts  were  estimated  to  be  about  eight 
millions.  All  the  organs  were  closely  examined,  but  no 
entozoa  were  found  in  any  of  them.  There  were  a  few  in 
the  diaphragm,  but  none  in  the  heart.  This  is  the  first 
case  that  has  ever  been  detected  in  this  hospital,  and,  so 
far  as  I  can  learn,  the  first  that  has  ever  been  reported  as 
occurring  in  Philadelphia." 

In  a  subsequent  communication,  Amer.  Jour.  Med.  Sci., 
January,  1870,  Dr.  Hough  states:  "Since  my  report  of 
the  two  cases  of  Trichiniasis  in  the  number  of  this  journal 
for  April  last,  I  have  detected  two  more,  and  am  inclined 
to  believe  that  these  entozoa  infest  the  human  muscles 
much  more  frequently  than  is  generally  supposed,  and  that 
they  may  be  present  in  numbers  ranging  from  six  to  hun- 
dreds of  millions.  I  am  positive  that  I  should  not  have 
detected  the  last  three  cases  had  I  not  discovered  the  first 
one.  Even  that  was  not  suspected  to  be  an  abnormal  con- 
dition of  the  muscles  by  two  of  the  physicians  whose  at- 
tention was  particularly  asked  in  regard  to  the  appearance 
presented  by  the  muscles.  One  called  them  air-bubbles 
under  the  fascia,  and  the  other  believed  the  appearance  to 
be  due  to  the  cut  ends  of  the  fibers  of  the  muscle  dried. 
Unless  the  trichinae  are  very  numerous,  they  will  not  be 
detected  by  one  who  has  never  seen  them  in  their  encysted 
state  in  the  muscle;  and  even  then  they  must  often  escape 
observation  where  their  presence  is  not  suspected." 

23* 


2G6  MEDICAL  MICROSCOPY. 

The  "Vinegar  eel,"  which  resembles  this  parasite  in  size 
and  general  appearance  (see  case  on  p.  147),  may  be  dis- 
tinguished by  its  tail  being  more  tapering  and  sharply 
pointed  than  the  head  of  the  Trichina,  whose  caudal  ex- 
tremity equals  the  thickness  of  any  portion  of  its  body, 
instead  of  tapering  like  the  head  of  the  eel  to  about  one- 
third  of  its  greatest  diameter. 

The  treatment  should  be  conducted,  to  use  that  hackneyed 
and  disappointing  phrase,  on  general  principles;  i.e.,  since 
no  remedy  which  will  destroy  the  parasite,  and  no  specific 
against  its  effects,  have  yet  been  discovered,  we  must  be 
content  to  combat  the  separate  symptoms  as  they  arise, 
and  to  the  best  of  our  ability  ;  relieving  the  pain  by  opium, 
lactucarium,  bromide  of  ammonium,  chloral,  etc.,  control- 
ling the  vomiting  with  lime-water,  bismuth,  or  creasote,  the 
diarrhoea  with  astringent  and  sedative  injections  or  sup- 
positories, and  meeting  the  prostration  by  means  of  tonics, 
stimulants,  and  beef  essence,  as  the  strongest  nutriment. 

Doctor  Edward  R.  Hun,  of  Albany,  N.Y.,  Microscopist 
to  the  State  Lunatic  Asylum  at  Utica,  and  one  of  the 
most  recent  authorities  upon  the  subject,  in  his  valuable 
resume  presented  to  the  State  Medical  Society  (vide 
Transactions  for  1869)  remarks:  "Notwithstanding  the 
various  remedies  employed,  we  must  acknowledge  that  as 
yet  no  very  marked  success  has  been  obtained  ;  and  this 
fact  may  be  due  to  the  remarkable  vitality  of  the  trichina, 
as  well  as  its  extreme  tenuity.  *  *  *  *  The  immense 
fecundity  of  this  entozoon  will  also  explain  how  the  escape 
of  a  few  adults  from  destruction  in  the  intestine  may  allow 
of  the  birth  of  thousands  of  embryos.  In  the  present 
state  of  our  knowledge,  we  can,  therefore,  consider  the 
preventive  measures  as  the  only  efficacious  means  to  be 
employed  against  the  disease." 

According  to  Dr.  Jackson,  "the  picronitrate  of  potash, 
from  which  so  much  was  expected  after  Friedrich's  cases, 


EX  A  MINA  TION  OF  IN  TEG  UMENT  AND  M  USOLES.      267 

has  been  demonstrated  by  Fiedler  and  others  to  be  of  no 
avail ;"  we  should  not,  however,  be  discouraged  in  our 
search  after  the  two  or  three  medicinal  substances,  which 
probably  exist,  poisonous  to  the  parasite  without  being 
noxious  to  the  individual  whom  they  inhabit,  and  conse- 
quently entitled  to  be  ranked  as  specifics  in  this  malady. 

The  cutaneous  affections  which  owe  their  origin  to  the 
development  of  microscopic  plants  (Epiphyta  and  Ento- 
phyta)  have  been  very  thoroughly  studied  by  Prof.  J.  H. 
Bennett,  of  Edinburgh,  and  more  recently  by  Dr.  Tilbury 
Fox,  of  London,  and  Dr.  M'Call  Anderson,  of  Glasgow,  to 
whose  work  on  the  subject  I  am  greatly  indebted.  Ac- 
cording to  Dr.  Fox,  the  pathognomonic  lesion  of  the  Tinese, 
as  he  styles  the  group  of  skin  diseases  which  are  caused 
by  cryptogamic  growths,  is  a  certain  altering  of  the  hairs 
of  the  part,  varying  in  degree,  but  present  in  every  instance 
of  fully-developed  disease,  being  least  in  Chloasma,  where 
the  hairs  are  really  unimportant  and  the  fungus  chiefly  at- 
tacks the  epithelium,  and  greatest  in  Tinea  tonsurans,  where 
the  capillary  appendages  suffer  most  severely.  Dr.  Fox 
states  that  after  having  performed  numerous  experiments 
with  diseased  hairs  out  of  the  body,  he  has  succeeded  in 
getting  a  hair  containing  spores  which  germinated  and  act- 
ually produced  the  splitting  up  of  the  hair  and  other 
changes  that  are  observed  in  ringworm, — in  fact,  produced 
"the  lesion  of  ringworm  out  of  the  body." 

The  symptoms  presented  by  a  patient  consulting  us  for 
an  eruption  upon  the  head  which  would  lead  us  to  suspect 
the  existence  of  FAVUS,  are,  especially,  the  occurrence  of 
bright-yellow  dry  crusts,  depressed  in  the  center,  through 
which  one  or  more  hairs  pass  which  have  a  dull,  dry  ap- 
pearance and  are  more  easily  extracted  than  natural,  the 
whole  exhaling  the  odor  of  mice.  If,  however,  the  affection 
is  of  longer  standing,  Favus  will  be  indicated  (although  the 
crusts  may  have  lost  their  cup-like  shape  and  bright-yellow 


268  MEDICAL  MICROSCOPY. 

color,  and  have  become  entangled  in  the  hairs)  by  the  facts 
that  the  hairs  are  dull,  dry,  discolored,  and  easily  extracted, 
and  that  patches  of  baldness  (apt  to  be  permanent)  have 
appeared.  Such  suspicions  may  sometimes  be  eluded, 
when  well  deserved,  by  the  mistaken  care  of  parents  in 
cleansing  all  the  crusts  from  the  head  of  a  child  before 
bringing  it  for  advice ;  but  here  the  characters  of  individual 
diseased  hairs  will  still  be  apparent,  and  doubts  generally 
may  be  solved  by  directing  that  the  patient  shall  be  brought 
back  after  the  lapse  of  a  week  or  two,  his  head  remaining 
in  the  mean  time  untouched.  The  cup-shaped  form  of  the 
crusts  is  invariably  assumed  when  Favus  attacks  the  hair- 
follicles  of  the  body.  Favus  of  the  nails  almost  always 
presents  itself  as  a  complication  of  the  disease  upon  the 
scalp,  and,  in  the  rare  exceptions  when  it  occurs  as  a 
primary  affection,  sometimes  presents  no  characteristic 
peculiarities  discernible  by  the  unassisted  vision. 

If  a  case  of  eruption  upon  the  head  supposed  to  be  Favus 
(Scall-head,  Honeycomb-Ringworm)  be  carefully  examined, 
it  will  be  found,  should  the  suspicions  be  correct,  that  in  an 
early  stage  little  yellow  specks  are  to  be  seen,  which  when 
examined  with  a  magnifying  glass  present  the  appearance 
of  minute  bright-yellow  crusts,  whose  central  depression  is 
perforated  by  one  or  more  hairs,  and  whose  base  is  sur- 
rounded by  an  inflammatory  areola  which  rises  above  the 
level  of  the  margin  of  the  cup-shaped  cavity.  In  a  more 
advanced  state  of  the  disease  these  yellow  crusts  increase 
in  magnitude  till  they  reach  a  diameter  of  about  one-fourth 
of  an  inch,  still  retaining  their  rounded  or  oval  form  and 
central  depression.  The  cup- shaped  crusts  may  very 
readily  be  removed;  and  it  is  remarkable  how  soon  the 
cavity  remaining  in  the  integument  disappears,  the  subcu- 
taneous tissue  compressed  by  the  growth  of  the  fungus 
rapidly  recovering  its  original  volume,  which  it  retains 
until  depressed  by  a  new  growth  of  the  parasite. 


r.YAMINATJON  OF  INTEGUMENT  AND  MUSCLES.      269 


In  order  to  detect  the  Achorion  Schcenleinii,  the  fungus 
of  Favus,  a  small  portion  of  one  of  the  yellow  crusts  may 
be  broken  up  with  mounted  needles  upon  a  slide,  a  drop 
of  liquor  potass®  added,  the  whole  covered  with  thin 
glass  and  examined  with  a  power  of  about  200  diameters. 
The  specimen  will  be  found  to  exhibit  (should  the  disease 
be  parasitic)  an  immense  quantity  of  granular  matter,  the 
so-called  siroma,  and  numerous  little  bodies  about  the  size  of 
red  blood  corpuscles,  averaging  -j-oVff  of  an  inch  in  diameter, 
oval,  rounded,  or  sometimes  marked  by  a  constriction, 
many  of  them  showing  an  appearance  of  nuclei  in  their 
interior.  These  bodies  are  the  spores  or  reproductive 
portions  of  the  Achorion,  and  are  generally  arranged  in 
chains  of  from  three  to  ten  or  more,  frequently  curved  and 
sometimes  branched.  Besides  these,  will  be  seen  numerous 
tubes,  often  branched,  some  empty,  some  with  granular 
contents,  either  simple  or  jointed,  as  if  formed  by  the  partial 
coalescence  of  a  number  of 
spores  united  at  their  ends. 
These  tubes  vary  from  TTr1TJ15- 
to  Y5^-on  of  an  inch  in  diam- 
eter, and  are  the  mycelia 
or  growing  portions  of  the 
Achorion.  (Fig.  26.) 

In  such  a  case,  the  hairs 
which  are  readily  extracted, 
and  especially  those  which 
break  off  on  the  application 
of  a  slight  force,  laid  upon  a 
slide  moistened  with  a  drop 

/.     T  ACHORION  ScHozNLti.N ii.  (After  Bennett.) 

of   liquor  potassae  and  ex-  x  300  Diajjer8- 

amilied     With      a     power      Of       Fragments  of  well-«leveloppd,  branching 

from  200  to  600  diameters,   fyce|l*'  Sp°res'f  and.  Gran,u'ar  matter> 

'    from  the  center  of  an  advanced  Favus  crust. 

exhibit  the  same  chains  of 

spores  ramifying  upon  their  surface,  and  also  penetrating 


Fio.  26. 


270  MEDICAL   MICROSCOPY. 

into  their  substance,  the  dry,  brittle,  and  discolored  con- 
dition being  apparently  caused  by  the  parasitic  growth 
robbing  the  hair  of  its  proper  nutriment  and  interfering 
with  its  development  by  a  more  or  less  severe  mechanical 
compression  near  the  root.  (See  remarks  on  Vine  Fungus, 
p.  168.)  In  investigating  a  case  of  supposed  Favus  for  the 
detection  of  the  Achorion,  an  inexperienced  microscopist 
will  be  liable  to  be  misled  by  the  presence  of  innumerable  oil 
globules,  which  sometimes  arrange  themselves  in  chains  of 
four  or  five  and  strongly  resemble  spores  to  the  unpracticed 
eye.  These  oil  globules  may  generally  be  distinguished  by 
the  fact  that  they  vary  in  size  and  are  almost  universally 
exactly  circular  in  outline ;  or,  if  the  observer  has  had  some 
experience  in  the  use  of  reagents  under  the  microscope,  all 
doubt  may  be  set  at  rest  by  acting  upon  them  with  Ether, 
which  will  at  once  dissolve  them.  Another  source  of  error 
might  be  the  occurrence  of  red  blood  corpuscles,  which,  as 
stated  above,  are  almost  identical  in  size,  and  liable  of 
course  to  be  present  when  the  integument  has  been  lacer- 
ated by  scratching,  and  if  distended  into  a  globular  form 
and  decolorized  by  water  (see  Fig.  6)  are  not  very  unlike 
spores  to  the  eye  of  a  student;  if,  however,  another  speci- 
men is  examined  in  the  carbolated  syrup  (seepage  37),  red 
blood  corpuscles  may  be  recognized  by  their  bi-concave 
shape,  while  the  spores  will  remain  unchanged,  presenting 
their  ordinary  oval  and  circular  outline.  As  a  means  of 
correcting  conclusions,  it  is  a  good  plan  to  examine  a 
healthy  hair,  and  a  few  particles  of  dandruff  from  one's  own 
head,  immersed  in  a  similar  menstruum  and  acted  upon  by 
the  same  reagents  ;  but  should  the  microscopist  have  the 
advantage  of  using  a  high  objective,  many  of  these  pre- 
cautions are  unnecessary,  a  very  hasty  examination  suf- 
ficing to  diagnosticate  between  spores,  oil  globules,  and 
blood  corpuscles. 

The  treatment  of  Favus  has  been  a  subject  of  much 


/•: X  iMlNATION  OF  INTEGUMENT  AND  MUSCLES.     271 

discussion  among  dermatologists,  some  authorities,  such 
as  Bazin,  Hebra,  and  Anderson,  maintaining  that  nothing 
short  of  epilation  or  extraction  of  the  hair  will  accomplish 
a  cure,  while  Bennett,  of  Edinburgh,  asserts  that  cures 
may  be  obtained  by  constitutional  and  local  treatment 
with  cod-liver  oil,  the  crusts  being  first  removed  by  the 
application  of  poultices ;  and  Erasmus  Wilson  condemns 
in  toto  the  cruelty  of  epilation,  which  he  humorously 
designates  "  the  purgatory  of  avulsion."  The  method 
practiced  in  the  St.  Louis  Hospital  is  thus  described  by 
Bazin :  "  Our  depilators  are  seated,  and  cause  the  head  of 
the  patient  to  rest  upon  their  knees  ;  with  one  hand  (gener- 
ally the  right)  they  hold  the  forceps  as  one  holds  a  writ- 
ing-pen ;  the  other  hand  is  applied  to  the  part  about  to  be 
depilated,  with  the  thumb  and  finger  of  which  they  put 
the  skin  on  the  stretch  to  keep  it  steady.  They  then 
extract  the  hairs,  pulling  them  out  in  the  direction  of  their 
axes,  and  only  a  small  number  at  a  time,  two,  four,  or  six, 
or  at  most  a  small  bundle.  It  is  necessary  to  avoid  de- 
pilating too  quickly  or  too  gently,  there  being  an  inter- 
mediate point,  which  one  can  only  arrive  at  after  a  little 
practice."  For  two  or  three  days  before  commencing  the 
epilation  the  scalp  (after  cutting  the  hair  to  the  length  of 
about  J  of  an  inch)  should  be  thickly  smeared  with  almond 
oil,  or  the  oil  of  Cade,  either  of  which  diminishes  the  sensi- 
bility of  the  skin  and  facilitates  the  operation.  As  a  gen- 
eral rule,  not  more  than  three  or  four  square  inches  of 
surface  covered  by  hair  can  be  cleared  daily,  so  that  when 
it  is  necessary  to  remove  the  whole  of  the  hair  from  the 
scalp  this  might  be  done  in  a  week  or  so ;  a  longer  time 
of  course  being  required  in  persons  who  are  very  sensitive. 
After  one  complete  depilation,  successive  partial  opera- 
tions are  frequently  requisite,  the  disease  often  not  being 
entirely  eradicated  in  all  portions  of  the  head;  bearing  in 
mind,  however,  that,  after  all  the  spores  of  Achorion  are 


272         .  MEDICAL  MICROSCOPY. 

destroyed,  secondary  eruptions  sometimes  remain,  which  of 
course  do  not  require  such  active  treatment.  The  ex- 
traction of  the  hair  by  means  of  the  Calotte,  a  sort  of  cap 
composed  of  strips  of  strong  cloth  covered  with  an  adhe- 
sive plaster,  which,  when  firmly  attached,  are  violently 
jerked  off,  is  still  practiced  in  France,  but  is  so  severe  that 
instances  of  death  from  this  cause  have  been  recorded. 
Among  the  parasiticides,  which  are  very  important  as 
adjuncts  to  the  process  of  epilation,  may  be  mentioned 
sulphur  and  sulphurous  acid,  turbith  mineral  and  corrosive 
sublimate,  the  last  of  which,  in  aqueous  solution  of  the 
strength  of  two  grains  to  the  ounce,  is  highly  recom- 
mended by  Dr.  Anderson,  whose  experience  with  carbolic 
acid  was  altogether  unsatisfactory.  Whichever  of  these 
remedies  is  employed  must  be  rubbed  into  the  scalp  every 
time  a  square  inch  of  surface  is  cleared  of  hair,  advantage 
being  thus  taken  of  the  expanded  condition  of  the  hair- 
follicles  to  insure  the  entrance  of  the  parasiticide.  A 
much  less  painful  method,  recommended  in  the  Edinburgh 
Medical  Journal,  September,  1869  (New  York  Medical 
Journal,  April,  1870),  is  that  of  removing  the  crusts, 
shaving  the  scalp,  and  painting  over  it  every  night  an 
aqueous  solution  of  chromic  acid  (5j  to  fgj)  until  decided 
irritation  is  produced.  The  application  is  said  to  be  uni- 
formly successful.  In  the  epidermic  variety  of  Favus, 
the  application  of  the  Corrosive  Sublimate  Lotion  is 
usually  sufficient  to  accomplish  a  cure.  When  Favus 
attacks  the  nails,  it  is  advised  to  file  away  the  portion 
covering  the  mass  of  Achorion,  and  apply  solution  of 
corrosive  sublimate  directly  to  the  growth.  Should  the 
disease  in  any  of  its  forms  occur  in  patients  of  a  strumous 
habit,  exercise,  pure  air,  cod-liver  oil,  and  preparations  of 
iron  are  important  adjuvants  to  local  treatment. 

In  the  second  class  of  vegetable  parasitic  skin  diseases 
the  prominent  symptom  which  should  excite  suspicion  in 


/.MM  .1//.V  I  TION  OF  1NTEG  UMENT  AND  MUSCLES.      273 

the  mind  of  the  medical  attendant  is  the  ring-like  shape  of 
the  eruption,  produced  by  a  tendency  of  the  growth  to  die 
out  in  the  center  after  a  few  days  or  weeks,  thus  allowing 
the  skin  in  that  part  to  regain  its  health,  while  the  con- 
stantly-developing fungus  at  the  margin  produces  an  ever- 
widening  zone  of  irritation,  giving  this  peculiar  form  to 
the  disease  from  which  it  derives  its  vulgar  name  of  Ring- 
worm. Dr.  M'Call  Anderson  teaches  that  Tinea  tonsurans 
or  Ringworm  of  the  head,  Tinea  circinata,  Ringworm  of 
the  body,  and  Tinea  sycosis,  Ringworm  of  the  beard,  etc. 
are  all  due  to  the  development  of  the  same  fungus,  which 
he  denominates  Tricophyton  ;  while  Dr.  Tilbury  Fox,  fol- 
lowing Gruby,  attributes  the  latter  of  these  maladies  to 
the  Microsporon  mentagrophytes.  The  minute  differences, 
however,  are  so  slight  that  they  will  hardly  be  noticed  by 
most  observers,  and,  as  the  important  point  is  really,  after 
all,  the  detection  of  a  cryptogamic  growth,  the  several 
diseases  and  the  method  of  discovering  them  may  be  de- 
scribed without  entering  upon  this  dispute. 

Tinea  tonsurans,  or  Ringworm  of  the  scalp,  is  a  conta- 
gious disease,  generally  met  with  in  children,  commencing 
in  little  points  or  rounded  erythematous  patches,  which 
soon  take  on  the  ring-like  character,  and  present  a  circle 
of  scaly,  vesicular,  or  (in  persons  of  very  sensitive  skin) 
even  of  pustular  eruption.  As  the  disease  advances,  the 
hairs  become  dull,  dry,  twisted,  and  easily  broken  or  ex- 
tracted, while  the  epidermis  and  stumps  of  the  hair  become 
covered  with  a  grayish-white  powder,  which  consists  of 
the  vegetable  growth.  Bazin  attaches  much  importance 
to  the  color  of  the  skin  in  these  patches,  stating  it  to  be 
bluish  or  slate-colored  in  people  of  dark  complexions,  and 
grayish,  reddish,  or  yellowish  in  fair  persons.  When 
inflammation  of  a  higher  grade  occurs,  small  subcutaneous 
tumors  or  tuberculated  masses  are  developed,  resembling 
those  observed  in  sycosis.  On  examining  the  hairs  in 

24 


274  MEDICAL   MICROSCOPY. 

both  these  affections,  the  bulbs,  except  in  an  an  early  stage 
of  the  disease,  are  found  to  be  flattened  and  disorganized, 
and  the  hairs  themselves  have  a  ragged,  splintered  appear- 
ance, the  longitudinal  fibers  being  split  apart  by  masses 
of  spores  penetrating  between  them,  while  at  different 
points  along  their  shafts  nodosities  are  developed  to  ac- 
commodate masses  of  spores. 

In  investigating  microscopically  a  case  of  supposed  Tinea 
tonsurans,  the  same  method  may  be  adopted  which  has 
been  already  advised  for  detecting  Favus;  a  few  hairs  and 
a  small  portion  of  the  whitish  dust  and  scaly  epithelium  of 
the  affected  part  being  moistened  with  liquor  potassae  on 
a  slide  and  examined  as  directed,  except  that  a  power  of 
500  or  600  diameters  should  be  employed,  taking  the  same 
precautions  to  avoid  being  misled  by  oil  globules,  blood 
corpuscles,  etc.  The  characteristics  of  the  Tricophyton 
which  are  said  to  distinguish  it  from  Favus  are,  the  mi- 
nute size  of  the  spores,  which  do  not  average  more  than 
^-i—^  of  an  inch  in  diameter  (less  than  half  that  of  a  red 
blood  corpuscle),  and  the  immense  number  of  these  rounded 
or  oval  spores  in  proportion  to  the  mycelial  threads  or 
tubes,  which  are  comparatively  rare ;  otherwise  the  mi- 
croscopic appearances  closely  resemble  those  described 
under  Favus  (Fig.  26).  The  diagnosis  from  Tinea  sycosis 
and  Tinea  circinata  is  to  be  made  simply  on  the  fact  of  its 
being  seated  upon  the  scalp,  instead  of  upon  the  face  or 
the  body  respectively ;  from  Pityriasis,  by  the  presence  of 
the  fungus,  by  the  occurrence  of  the  disease  in  patches 
more  or  less  circular,  instead  of  distributed  over  the  whole 
head,  by  being  communicable  instead  of  non-contagieus, 
and  by  the  brittleness  and  feeble  attachment  of  the  hairs, 
which  in  Pityriasis  are  comparatively  unaffected ;  from 
Psoriasis  capitis,  by  "the  existence  of  the  fungus,  the  affec- 
tion of  the  hairs,  and  by  the  scales  being  thinner  and  less 
silvery,  while  in  most  cases  of  psoriasis  patches  occur  on 


EXAMINATION  OF  INTEGUMENT  AND  MUSCLES.     275 

other  parts  of  the  body,  especially  the  elbows  and  knees ; 
from  Eczema  impetiginodes  of  the  head,  by  the  fact  that  in 
the  latter  the  parasite  is  absent,  the  hairs  healthy,  the 
patches  of  disease  not  circular,  the  itching  often  intense, 
the  affection  not  contagious  and  complicated  with  eczema- 
tons  eruptions  on  other  parts  of  the  body.  In  cases  where 
Tinea  tonsurans  complicates  Eczema  capitis,  the  micro- 
scopic appearances  are  the  chief  aids  to  arriving  at  a 
correct  diagnosis,  although  some  assistance  may  be  ob- 
tained from  the  history  of  the  attack  and  its  contagious 
nature. 

Like  the  Achorion,  Tricophyton  sometimes  attacks  the 
nails,  presenting  similar  appearances,  except  that  the  mass 
of  fungous  growth  is  of  a  grayish-white  color,  instead  of 
a  yellow  tint ;  such  cases  are,  however,  rare. 

Tinea  circinata  (Herpes  circinatus,  Ringworm  of  the 
body)  generally  commences  as  a  little,  rose-colored,  slightly 
elevated  spot,  which  in  a  few  days  becomes  the  seat  of 
slight  furfuraceous  desquamation,  and  is  accompanied  by 
itching  or  tingling;  after  a  time  the  center  of  this  spot 
heals,  while  the  circumference,  constantly  enlarging,  may 
attain  a  diameter  of  four  or  five  inches,  its  margin  being 
composed,  according  to  the  patient's  susceptibility  to  irri- 
tation, of  a  ring  of  erythematous,  vesicular,  or  pustular 
eruption. 

The  microscopic  examination  is  to  be  made  as  directed 
above,  extracting,  if  possible,  a  few  of  the  fine  hairs,  and 
scraping  off  with  a  sharp  scalpel  some  of  the  epithelial 
cells  which  constitute  the  upper  layer  of  the  epidermis  or 
have  already  desquamated.  A  power  of  500  diameters 
should  be  used,  with  which  isolated  spores,  chains  of  spores, 
and  a  few  mycelial  threads  may  be  seen  ramifying  among 
the  epithelium ;  but  in  order  to  verify  his  conclusions  the 
student  should  examine  some  scrapings  of  skin  from  a 
corresponding  portion  of  his  own  body. 


276  MEDICAL   MICROSCOPY. 

The  diagnosis  from  Erythema  circinatum  is  to  be  made 
by  the  existence  of  the  parasite,  the  history  of  the  case, 
the  contagious  nature  of  the  disease,  and  the  distinct  ele- 
vation which  generally  characterizes  the  ring  of  Tinea 
circinata ;  from  an  erythematous  syphilitic  eruption,  by 
the  history  of  the  case  and  absence  of  other  secondary 
symptoms,  by  the  presence  of  the  fungus,  by  the  tendency 
to  itching,  and  by  being  asymmetrical  in  its  occurrence ; 
and  from  Favus  of  the  epidermis,  by  the  smaller  size  of  the 
spores,  the  much  greater  magnitude  of  the  rings,  the 
whitish  instead  of  yellow  color  of  the  scales,  and  its  asso- 
ciation in  most  instances  with  well-marked  ringworm 
instead  of  Favus  of  the  head. 

The  circular  variety  of  Psoriasis,  when  passing  off,  and 
after  the  thick  white  scales  have  fallen,  may  resemble  Tinea 
circinata,  but  can  generally  be  distinguished  by  the  absence 
of  the  fungus,  the  history  of  the  case,  and  the  occurrence 
of  similar  patches  upon  the  knees  and  elbows. 

Tinea  sycosis  commences  in  typical  cases  in  small  ery- 
thematous spots,  which  have  a  tendency  to  heal  in  the  cen- 
ter, and  spread  at  the  circumference,  leaving  rosy  circles,  or 
segments  of  circles,  covered  with  furfuraceous  desquama- 
tion.  Many  of  the  hairs  in  the  affected  surface  are  broken 
off  close  to  the  skin,  while  those  which  remain  entire  can 
readily  be  extracted,  and  are  often  covered  with  a  white 
powder,  the  spores  and  mycelia  of  Tricophyton.  At  this 
stage  the  irritation  is  not  very  great ;  but,  as  the  disease 
progresses,  papules  and  pustules  form  at  the  orifices  of  the 
hair-follicles,  the  deeper  structures  are  involved,  so  that 
small  indurations  occur,  surmounted  by  pustules  resembling 
those  of  acna3,  and  finally,  as  the  cellular  tissue  becomes 
implicated,  large  tubercles  appear,  and  present,  on  removing 
their  covering  crusts,  the  roughly  granulated  surface,  not 
unlike  the  pulp  of  a  fig,  from  which  the  name  sycosis  (ffuxov, 
a  fig)  is  derived.  If  the  affection  proceed  still  further,  the 


EXAMINATION  OF  INTEGUMENT  AND  MUSCLES.      277 

whole  surface  of  the  chiu  becomes  very  rough,  the  hairs 
break  off  on  a  level  with  the  skin,  or  a  couple  of  lines 
from  it,  and  at  last  fall  out  entirely,  while  in  some  cases 
large  segments  of  circles  extend  round  the  front  of  the 
neck,  beneath  the  beard,  from  ear  to  ear,  and  similar 
patches  are  not  uncommon  over  the  top  of  the  sternum, 
and  on  the  wrist,  owing  to  the  patient  rubbing  his  chin 
with  these  parts.  It  must  not  be  forgotten  that,  as  a 
general  rule,  when  the  physician  is  consulted,  this  disease 
is  so  far  advanced  that  careful  examination  is  necessary  to 
detect  the  few  circles  of  eruption  which  remain. 

The  microscopic  examination  is  to  be  made  as  directed 
under  Favus,  and  the  appearances  will  be  found  to  re- 
semble those  observed  in  T.  tonsurans  and  T.  circinata. 

The  diagnosis  of  this  disease  is  to  be  made  from  Eczema 
impetiginodes  of  the  hairy  portions  of  the  face  (impetigo 
menti)  by  the  presence  of  the  fungus,  and  its  appearance 
in  discrete  erythematous  patches,  while  the  non-parasitic 
affection  is  originally  pustular,  and  strongly  tends  to  be- 
come confluent;  from  syphilitic  complaints,  by  the  history 
of  the  case,  the  extensive  alterations  of  the  hair,  and  the 
presence  of  the  fungus. 

In  regard  to  the  mode  of  infection  of  these  three  dis- 
eases, some  very  interesting  observations  published  by 
Prof.  J.  H.  Salisbury,  of  Cleveland,  Ohio,  in  the  Amer. 
Jour,  of  Med.  Sci.  for  April,  1867,  p.  379,  and  by  R. 
Cresson  Stiles,  M.D.,  in  the  New  York  Medical  Record, 
vol.  ii.  p.  340,  prove  that  it  may  readily  be  conveyed  from 
the  lower  animals,  as  cats  and  mice,  to  human  beings,  and 
render  it  highly  probable  that  such  sources  of  contagion 
really  account  for  many  cases  in  which  these  maladies 
have  hitherto  been  deemed  idiopathic  in  their  origin. 

"  The  treatment  of  Tinea  tonsurans  should  be  both  con- 
stitutional and  local,  the  former  consisting  of  exercise, 
fresh  air,  cod-liver  oil,  and  other  tonics ;  the  latter,  of  the 

*24* 


278  MEDICAL   MICROSCOPY. 

application  of  parasiticidic  lotions  or  ointments,  preceded 
in  severe  or  obstinate  cases  by  a  more  or  less  complete 
epilation,  as  directed  under  Favus.  In  addition  to  the  lotion 
of  corrosive  sublimate  and  other  remedies  (referred  to  on 
page  272),  the  Tinct.  Ferri  Chloridi,  U.  S.  P.,  is  very  effect- 
ual, and  I  have  known  ointments  to  accomplish  a  cure  with- 
out resorting  to  the  painful  process  of  removing  the  hair." 

The  most  characteristic  indication  of  Tinea  versicolor, 
which  constitutes  Dr.  Anderson's  third  class  of  Parasitic 
diseases  of  the  skin,  is  the  peculiar  brownish  color,  vary- 
ing in  intensity,  from  which  the  name  of  Maculse  hepaticse, 
or  Chloasma,  is  derived.  This  affection,  attributed  to  the 
growth  of  the  MICROSPORON  FURFUR,  generally  makes  its 
appearance  in  little  spots  about  the  size  of  a  pin's  head, 
which  gradually  increase  in  size,  retaining  their  circular 
form,  but  not  healing  i»  the  center,  as  is  the  case  with 
ringworm.  Gradually  these  spots  unite,  forming  upon  the 
trunk  large  irregular  patches,  near  the  edges  of  which  we 
may  usually  detect  small  spots  of  eruption,  which  are 
very  characteristic.  The  skin  of  the  affected  surface  is 
scarcely,  if  at  all,  elevated  above  the  surrounding  parts, 
but  is  less  smooth  than  in  health,  and  is  frequently  the 
seat  of  a  very  fine  desquamation,  so  fine  as  to  resemble 
dust,  and  having  a  slight  yellowish  tint.  The  itching  is 
generally  moderate,  sometimes  almost  absent,  and  occa- 
sionally very  severe,  although  not  specially  aggravated  at 
night. 

The  microscopic  examination  may  be  made  by  scraping 
off  some  of  the  fine,  powdery,  epithelial  scales  upon  a  slide, 
moistening  them  with  liquor  potassae,  and  examining  under 
a  power  of  200  to  400  diameters,  taking  care  to  test  any  sup- 
posed groups  of  spores  by  the  addition  of  sulphuric  ether, 
which  will  dissolve  the  suspicious  objects  should  they  be 
only  oil  globules  ;  the  spores  of  Microsporon  furfur,  if  pres- 
ent, will  be  seen  of  a  rounded  form  from  ^ -$  to 


EXAMINATION  OF  INTEGUMENT  AND  MUSCLES.      279 

an  inch  in  diameter,  often  clustered  together  in  large 
masses  like  bunches  of  grapes,  which  are  very  character- 
istic;  the  mycelial  threads  are  remarkable  for  their  length, 
which  peculiarity  is  best  seen  if,  as  advised  by  Gudden,  a 
small  blister  is  applied  to  some  affected  part,  and  a  portion 
of  cuticle  thus  detached  examined  under  the  microscope. 

The  diagnosis  is  to  be  made  from  vitiligo  and  from  ephe- 
lis  by  the  presence  of  the  fungus,  the  history  of  the  case 
(non-congenital),  and  the  pruritus,  desquamation,  and  ele- 
vation of  the  skin,  all  of  which,  though  slight  in  degree, 
are  generally  present ;  from  Pityriasis  vulgaris,  sen  alba, 
by  the  existence  of  the  parasite,  and  the  small,  thin,  scanty, 
and  yellowish  scales  which  constitute  its  desquamation ; 
and  from  syphilitic  eruptions  which  it  may  complicate,  by 
the  detection  of  the  fungus,  and  by  little  spots  of  eruption 
about  the  size  of  pins'  heads,  generally  to  be  seen  at  the 
edges  of  its  patches. 

The  treatment  consists  of  the  application  of  the  Tinctura 
Ferri  Chloridi,  the  Corrosive  Sublimate  Lotion,  or  some 
other  parasiticide,  which  should  be  continued  for  some 
weeks  after  all  traces  of  the  disease  have  disappeared,  in 
order  to  accomplish  a  permanent  cure.  When  frequent 
relapses  occur,  Dr.  Anderson  (op.  cit.)  mentions  the  internal 
use  of  arsenic,  "persevered  in  for  some  time,  with  a  view 
of  changing  the  state  of  system  favorable  to  the  growth 
of  the  vegetable." 

According  to  Gruby,  Bazin,  Tilbury  Fox,  and  other  au- 
thorities, the  disease  called  Alopecia  areata  (Tinea  clecal- 
vans,  Alopecia  circumscripta)  is  caused  by  the  development 
of  a  fungus  named  by  the  first  of  these  observers,  who 
discovered  it  in  1843,  MICROSPORON  ADOUINI. 

This  curious  affection  commences  with  a  little  redness 
and  itching  of  some  small  spot  upon  the  scalp,  often  so 
slight  as  to  pass  unnoticed  until  the  hairs  fall  out,  and  the 
patient  is  surprised  to  find  a  smooth,  round,  white  patch 


280  MEDICAL  MICROSCOPY. 

of  baldness  upon  his  head  ;  occasionally  several  of  these 
occur,  and,  coalescing,  form  a  spot  somewhat  serpentine 
in  outline,  from  which  the  affection  derives  its  synonym  of 
Ophiasis.  It  appears  to  be  contagious  in  its  character, 
and  is  sometimes  communicated  to  the  nails  by  scratching. 

The  fungus,  which  Dr.  Anderson,  with  all  his  experience 
in  Parasitic  diseases,  has  never  been  able  to  detect,  is  de- 
scribed as  consisting  of  minute  not  very  numerous  spores, 
and  mycelial  threads,  which  are  more  abundant;  these 
ramify  among  the  epithelial  cells,  and  penetrate  the  interior 
of  the  hairs,  where  they  give  rise  to  marked  dilatations.  I 
am  inclined  to  think  that  this  complaint  is  not  very  rare  in 
our  ow%  country,  but  apt  to  be  passed  over  without  much 
attention.  The  only  case  I  have  seen,  and  that  non- 
professionally,  was  one  of  two  or  three  which  occurred  in 
a  large  boarding-school  near  this  city.  The  patient  was  a 
young  lady,  about  fourteen  years  of  age,  in  whom  a  bald 
spot,  about  half  an  inch  in  diameter,  appeared,  without 
any  obvious  cause,  near  the  vertex,  and,  after  some  months, 
became  again  covered  with  hair.  No  treatment  was  in- 
stituted, nor  was  opportunity  offered  for  any  microscopic 
investigation  of  the  case. 

In  the  management  of  this  disease,  the  parasiticides 
previously  recommended  are  chiefly  to  be  relied  upon ; 
and  to  the  list  given  above  may  be  added  the  ointment  of 
the  red  iodide  and  the  nitrate  of  mercury,  which  are  ad- 
vised by  Dr.  Wilson  as  stimulants,  on  the  ground  that 
Area  must  be  considered  <(a  kind  of  paresis  of  innervation." 

As  remarked  by  Dr.  T.  Fox  (Practitioner,  March,  1870, 
p.  138),  in  the  local  treatment  of  the  various  forms  of 
Tinea  ''the  microscope  must  be  constantly  used  to  deter- 
mine when  the  destruction  of  the  parasite  is  effected  and 
the  hair-forming  apparatus  is  doing  its  work  fairly,  lest 
we  produce  irritation  that  is  taken  for  an  increase  of  the 
disease." 


EXAMINATION  OF  INTEGUMENT  AND  MUSCLES.      281 

This  chapter  upon  Epiphytic  diseases  would  be  incom- 
plete without  a  brief  reference  to  the  occurrence  of  Fungous 
growth  in  the  external  auditory  meatus,  which,  although 
rarely  observed,  probably  takes  place  in  many  cases  where 
it  has  been  hitherto  overlooked.  The  symptoms  which 
should  direct  attention  to  this  form  of  aural  affection  are 
the  occlusion  of  the  meatus  by  a  lardaceous  mass,  some- 
what resembling  inspissated  cerumen,  but  very  adherent 
to  the  walls  of  the  canal,  which,  when  it  is  peeled  off,  are 
left  more  or  less  inflamed,  and  in  a  few  days  again  become 
covered  with  the  obstructive  material.  The  microscopic 
investigation  should  be  made  by  tearing  up  a  minute  frag- 
ment of  the  mass  with  mounted  needles,  in  a  drop  of  gly- 
cerin or  of  liquor  potassae,  upon  a  slide,  covering  it  with 
thin  glass,  and  examining  it  with  a  power  of  200  diame- 
ters. The  two  forms  of  fungus  hitherto  detected  are  the 
Aspergillus  nigricans  and  the  Aspergillus  flavescens,  whose 
spores  and  mycelia  somewhat  resemble  those  of  the 
Achorion  figured  on  page  269.  Both  of  these  plants  are 
delineated  in  a  very  interesting  paper  by  Drs.  St.  John 
Roosa  and  Win.  B.  Lewis,  in  the  number  of  the  Am. 
Jour,  of  Med.  Sciences  for  January,  1870,  to  which  the 
reader  is  referred. 


CHAPTER   XI  V. 

MEDICO-LEGAL   INVESTIGATION   IN    REGARD    TO    STAINS   OF 
BLOOD,   SPERMATIC   FLUID,  ETC. 

THE  medical  practitioner,  when  called  upon  to  give  evi- 
dence before  a  legal  tribunal  in  regard  to  stains  suspected  of 
being  produced  by  the  blood  of  a  murdered  person,  should, 
if  possible,  be  prepared  to  meet  the  arguments  of  ingenious 
counsel  (who  may  affirm  that  various  diseases,  as,  for  ex- 
ample, leucocythaemia,  anaamia,  etc.,  might  have  existed, 
and  so  invalidate  the  testimony)  with  specimens  of  blood 
drawn  from  the  corpse  itself  and  spread  out  in  thin  films 
upon  glass  slides,  and  also  with  spots  made  upon  the 
identical  articles  of  clothing  worn  by  tKe  supposed  crim- 
inal at  the  time  of  the  homicide,  in  order  to  have  a  pos- 
itive and  indisputable  standard  with  which  to  compare 
his  results.  Among  the  various  methods  with  which 
scientific  research  has  armed  us,  for  the  discovery  of  blood- 
stains, may  be  enumerated — first,  the  detection  of  red  cor- 
puscles by  the  aid  of  the  microscope  ;  second,  the  recog- 
nition of  crystals  of  haematin  ;  third,  its  discrimination  by 
means  of  chemical  tests ;  and  fourth,  through  the  investi- 
gations of  Mr.  Sorby,  we  have,  by  the  aid  of  the  spectro- 
scope, an  additional  method,  claimed  to  be  more  delicate 
than  any  previously  in  use  for  the  detection  of  blood. 

From  observations  of  my  own  (published  in  the  Ameri- 
can Journal  of  Medical  Sciences  for  July,  1869),  however, 
it  would  appear  that  the  first  of  these  methods  is  the  most 
accurate,  and  by  it  we  are  capable  of  distinguishing  much 
(282) 


STAINS  OF  BLOOD,  SPERMATIC  FLUID,  ETC.     283 

smaller  quantities  of  blood  than  by  either  of  the  other 
plans,  which  I  compare  as  to  their  relative  capacity,  as 
follows: 

"By  the  intricate  and  tedious  method  of  M.  Taddei 
(Fabre,  Biblioth&que  du  Medecin  Practicien,  tome  xv.  p. 
264,  Paris,  1851),  'a  piece  of  linen  or  cotton,  which  hardly 
contained  28  to  30  centigrammes  (between  four  and  five 
Troy  grains)  of  dried  blood,  furnished  enough  for  determi- 
nation of  its  nature.' 

"A  plan  suggested  by  Dr.  F.  Runge,  in  which  the  iron 
of  the  blood  was  tested  for  by  ferrocyanide  of  potassium, 
is  spoken  of  by  Dr.  Fleming  as  being  so  very  delicate  that 
a  single  drop  of  blood  sufficed  for  complete  detection. 

"By  spectrum  analysis,  lately  vaunted  as  successful 
when  ordinary  microscopic  examination  fails,  it  is  claimed 
that  -nfa  of  a  grain  of  dried  blood  may  be  recognized, 
but  no  clue  is  thus  afforded  to  the  animal  whence  the  vital 
fluid  is  derived. 

"  Through  the  courtesy  of  Dr.  Linderman,  Director,  and 
Mr.  J.  K.  Eckfelt,  Chief  Assayer  of  the  United  States 
Mint,  I  was  enabled  to  estimate  the  delicacy  of  the  micro- 
scopic tests  for  blood  as  follows :  Upon  a  square  of  waxed 
paper,  determined  by  Mr.  Eckfelt  on  the  accurate  balance 
used  for  the  national  assays  to  weigh  exactly  48  milli- 
grammes, I  made  twenty  dots  of  fresh  blood  from  my 
finger,  which,  when  dry,  added  -4  of  a  milligramme  to  the 
original  weight,  and,  consequently,  were  each  on  an  aver- 
age equivalent  to  about  '02  of  a  milligramme,  or  ^Q-Q  of 
a  Troy  grain,  nearly.  The  fourth  part  of  one  of  these 
spots,  weighing  of  course  in  round  numbers  T-^TJIF  °f  a 
grain,  was  detached  with  the  point  of  a  cataract-needle, 
and  when  moistened  under  the  -^  showed  many  hundred 
well-defined  red  blood  corpuscles.  Ten  circular  ones 
among  these,  measured  with  the  micrometer,  averaged 
of  an  inch  in  diameter,  and  could,  therefore,  by  this 


284  MEDICAL  MICROSCOPY. 

criterion  of  superior  size  alone,  be  diagnosticated  from  the 
corpuscles  of  an  ox,  sheep,  or  pig  with  the  same  feeling  of 
certainty  with  which  any  surgeon  could  testify  that  a  per- 
foration of  the  skull  only  half  an  inch  across  could  not 
possibly  have  been  made  by  a  bullet  measuring  an  inch  in 
diameter." 

Supposing,  now,  that  the  microscopist  is  applied  to  for 
the  purpose  of  determining  the  character  of  a  compara- 
tively fresh  stain  resembling  blood,  he  may  adopt  the  fol- 
lowing method  for  examination.  Experience  has  shown 
that  dried  spots  of  blood  upon  hard  smooth  surfaces,  such 
as  buttons,  studs,  etc.,  most  readily  exhibit  the  corpuscles; 
next  to  these,  in  ease  of  detection,  are  stains  upon  paper 
collars  or  cuffs,  and  upon  highly  glazed  linen  ;  then  those 
upon  unstarched  muslin  or  linen ;  and  lastly,  those  upon 
cloth  and  other  woolen  fabrics.  Should,  therefore,  the  ob- 
server be  able  to  discover  any  well-defined  spots  upon 
buttons  or  studs,  let  him  remove  a  particle  the  size  of  a 
grain  of  writing-sand  with  the  point  of  a  cataract-needle, 

FIG.  27. 


Delicate  CELL-WALLS  OF  RED  BLOOD  CORPUSCLES,  also  LEUCOCYTE,  showing  two 
nuclei ;  from  fragment  of  a  blood-stain  acted  upon  by  water.     X  1200  Diameters. 

letting  it  fall  upon  a  slide  which  has  been  carefully  cleaned. 
A  thin  glass  cover  should  then  be  laid  upon  the  minute 
fragment,  pressed  down  firmly  so  as  to  crush  the  particle 


STAINS   OF  BLOOD,  SPERMATIC  FLUID,  ETC.     285 

into  powder,  and  the  whole  transferred  to  the  stage  of  the 
microscope.  After  finding  a  suitable  portion  of  clot  with 
a  thin  beveled  edge,  pure  water  should  be  introduced  at 
the  margin  of  the  cover  and  allowed  to  flow  very  slowly 
toward  the  chosen  specimen ;  when  this  is  reached  by  the 
wave  of  fluid,  a  remarkable  appearance  of  boiling  up  from 
its  center  is  presented  for  a  few  moments,  and  then,  as 
the  tinged  liquid  is  replaced  by  a  clear  water,  an  aggrega- 
tion of  compressed  corpuscles  (Fig.  27),  very  faint  and 
colorless,  but  yet  of  unquestionable  distinctness,  becomes 
apparent,  if  a  lens  of  sufficiently  high  power  and  superi- 
ority of  definition  is  employed.  A  few  straight,  interlaced 
filaments  of  fibrin  are  often  visible,  and  at  intervals  the 
granular,  spherical  lymph  globules  occur  among  the  other 
elements.  These  white  cells  frequently  become  detached 
and  float  freely  around  the  edges  of  the  clot,  where,  as 
well  as  whilst  still  imbedded,  they  are  so  much  more 
readily  recognized  with  a  low  power  that  I  am  confident 
they  have  often  been  mistaken  for  the  red  disks ;  indeed, 
an  experienced  teacher  of  microscopy  has  acknowledged 
to  me  that  in  his  own  examinations  he  has  sometimes 
been  obliged  to  rely  on  the  discovery  of  white  corpuscles 
alone,  the  red  globules,  as  a  rule,  escaping  detection,  a 
fact  which  I  should  attribute  to  his  employment  of  lenses 
insufficient  in  magnifying  and  defining  power  for  the 
recognition  of  the  red  corpuscle's  cell-wall  (see  page  IT 6). 
Should  a  difficulty  be  found  in  distinguishing  the  outlines 
of  the  decolorized  corpuscles,  they  may  be  rendered  far 
more  obvious  by  introducing  at  the  margin  of  the  cover  a 
minute  portion  of  iodine  or  aniline  solution  (see  page  3T), 
and  can  then  often  be  distinguished  even  by  inexperienced 
observers.  In  making  such  examinations,  "great  care 
must  be  taken  to  avoid  any  movement  of  the  cover  upon 
the  slide,  which,  when  it  occurs,  often  rolls  the  interposed 

25 


286  MEDICAL  MICROSCOPY. 

disks  into  an  apparently  homogeneous  mass ;  and  it  is  ad- 
visable to  keep  up  a  current  of  fresh  water  until  all  tinge 
of  color  is  removed  from  the  clot,  otherwise  none  but  the 
granular  lymph  corpuscles  may  be  visible.  In  order  to 
complete  a  chain  of  evidence  it  is  probable  that  the  decol- 
orized corpuscles  in  a  fragment  of  clot,  after  being  ren- 
dered more  distinct  by  iodine  or  aniline,  as  above  mentioned, 
might  often  be  demonstrated,  if  required  in  court,  to  in- 
telligent jurymen,  especially  where,  as  surveyors,  watch- 
makers, or  engravers,  the  jurors  were  more  or  less  accus- 
tomed to  the  use  of  lenses." 

Should  it  be  required  to  determine  the  character  of  a 
stain  upon  a  piece  of  unstarched  linen  or  muslin,  the  spot 
in  question  should  be  carefully  inspected  with  a  hand  mag- 
nifier or  one  of  the  low  objectives,  as,  for  instance,  the  one 
inch,  and  some  minute  particle,  such  as  can  almost  always 
be  discovered,  detached  from  among  the  vegetable  fibers  by 
means  of  a  cataract-needle,  and  deposited  upon  a  slide,  the 
tiniest  fragment  scarcely  visible  to  the  naked  eye  being 
often  sufficient  to  exhibit  hundreds  of  corpuscles,  which 
may  be  detected  by  examination  as  above  described ;  or  the 
fabric  may  be  scraped  with  a  sharp  scalpel  over  a  slip  of 
glass,  the  larger  particles  of  lint  picked  out,  and  the  red 
dust  which  remains  covered  with  the  glass  and  subjected 
to  examination. 

Blood-stains  upon  cloth  or  other  woolen  material  present 
the  greatest  difficulties  in  the  recognition  of  their  red  cor- 
puscles, and  in  some  cases,  where  they  have  been  exposed 
to  the  destructive  action  of  air  and  moisture,  may  be  so 
far  disintegrated  as  to  be  unrecognizable  by  this  means  of 
observation.  The  effort  should,  however,  always  be  made 
to  discover  under  a  hand -magnifier  some  small  aggregation 
of  the  corpuscular  elements  which  may  be  tested  in  the 
manner  just  noted,  the  great  difficulty  being  to  obtain  some 
fragment  large  enough  to  have  escaped  the  complete  loss 


STAINS  OF  BLOOD,  SPERMATIC  FLUID,  ETC.      287 

of  its  liquid  ingredients  by  absorption  and  consequent  com- 
pression into  a  nearly  homogeneous  mass,  while  still  in  a 
softened  condition. 

It  is  almost  useless  to  attempt  such  an  investigation 
without  the  aid  of  superior  objectives  of  high  power,  viz.  of 
about  -j1^  of  an  inch  focal  length.  At  least,  some  of  the  most 
experienced  authorities,  working  with  inferior  lenses,  have 
been  compelled  to  acknowledge  their  inability  to  distinguish 
blood  corpuscles  in  the  dried  clot ;  for  example,  Dr.  Flem- 
ing observes:  "From  the  experiments  which  I  have  made 
during  a  period  of  several  years  with  blood  belonging  to 
different  animals,  when  dried  for  a  length  of  time  and 
moistened  again,  I  am  forced  to  admit  that  great  difficulty 
arises  in  attempting  to  fix  its  origin  by  the  comparative 
size  of  the  corpuscles  ;"  and  again,  "  that  the  blood  of 
ovipara,  when  kept  for  several  weeks,  does  not  present  the 
peculiar  elliptical  corpuscles  found  in  fresh  blood  in  a  form 
sufficiently  perfect  to  justify  me  in  declaring  positively 
whence  it  proceeds."  And  Professor  Wyman  asserts  that 
"  If  a  drop  of  blood  be  rubbed  on  a  piece  of  glass,  as  by 
drawing  a  bloody  finger  across  it,  so  that  the  disks  are  de- 
posited in  a  single  layer  and  then  allowed  to  dry,  they  are 
readily  recognized  even  in  the  dried  state  ;  but  when  al- 
lowed to  dry  in  masses  I  have  failed  to  determine  their 
presence ;  the  lymph  globules,  on  the  contrary,  may  be 
softened  out  after  they  have  been  dried  for  months,  and 
their  characteristic  marks  readily  obtained."  According 
to  my  own  experiments,  however,  it  would  appear  that 
"  when  the  disks  have  not  undergone  disintegration  a' first- 
rate  2*5-  inch  objective  will  enable  us  to  detect  their  pres- 
ence easily  and  beyond  all  question." 

Presuming  now  that  the  corpuscles  of  blood  have  been 
recognized,  the  question,  from  what  animal  the  fluid  is  de- 
rived, becomes  a  further  problem  for  investigation.  And 
"  although  it  must  be  admitted  that  the  blood  corpuscles 


288  MEDICAL  MICROSCOPY. 

of  a  few  mammals  approach  so  nearly  in  size  to  those  of 
man  as  to  render  their  distinction  doubtful,  yet  for  the 
practical  testing  of  blood-stains  in  criminal  trials  we  will 
rarely  find  that  such  a  decision  is  necessary,  since,  as  a 
rule,  justice  only  requires  that  a  positive  diagnosis  shall  be 
made  between  human  blood  and  that  of  animals  which  are 
commonly  slaughtered  for  food,  such  as  the  ox,  the  sheep, 
or  the  pig ;  and  of  birds,  as,  for  example,  chickens,  ducks, 
etc."  Drs.  Carpenter  and  Flint,  following  Gulliver,  state 
that  the  average  diameter  of  the  red  corpuscle  in 

Man is    1-3200  of  an  inch. 

Orang-Outang 1-3383  "  " 

Dog 1-3542  «  " 

Whale 1-3099  " 

Kabbit 1-3607  "  " 

Eat  (black) 1-3754  «  « 

Eaccoon 1-3950  "  " 

Eed  Squirrel 1-4000  "  " 

Fox 1-4117  "  " 

Pig 1-4230  «  " 

Ox 1-4267  "  " 

Eed  Deer 1-4324  " 

Cat 1-4404  "  " 

Horse 1-4600  "  " 

Sheep 1-5300  " 

Goat 1-6366  « 

Musk  Deer  of  Java 1-12325  "  " 

Long  Diam.  Short  Diam. 

Camel 1-3123  1-5876 

Sparrow 1-2140  1-3500 

Pigeon 1-1973  1-3643 

Cock 1-2102  1-3466 

Duck 1-1937  1-3424 

Lizard 1-1555  1-2743 

Frog 1-1108  1-1821 

Perch 1-2099  1-2824 

From  this  table  it  will  be  seen  that,  although  "it  is 


STAWS  OF  BLOOD,  SPERMATIC  FLUID,  ETC.     289 

true  the  older  microscopists,  who  rarely  obtained  first-rate 
definition  with  their  lenses  magnifying  much  beyond  500 
diameters,  were  probably  wise  in  recommending  that  none 
but  the  most  expert  should  attempt  a  decision  between  the 
blood  of  various  mammalia,  even  when  fresh,  for  the  dif- 
ference between  an  apparent  magnitude  of  y\T  and  •£%  of  an 
inch  may  well  be  counted  too  minute  to  lightly  determine 
a  question  often  so  momentous;  yet,  as  during  the  last 
three  or  four  years  op.ticians  have  furnished  immersion 
lenses  of  ^5-  and  -fa  of  an  inch  focal  length,  the  former 
rendering  the  apparent  size  of  a  red  disk  from  fresh  human 
blood  five-sevenths  of  an  inch,  while  that  from  ox  blood  is 
but  half  an  inch  across,  and  consequently  little  more  than 
half  the  area  as  seen  upon  the  stage,  it  seems  as  if  any 
careful  observer  might  now,  with  the  aid  of  such  objectives, 
be  qualified  to  pronounce  a  positive  opinion.  It  has  been 
plausibly  objected,  however,  as  by  Prof.  Vircbow,  that 
since  the  diagnosis  of  the  different  species  of  mammalian 
blood  depends  solely  upon  the  relative  size  of  the  red  disk, 
variation  in  the  rapidity  of  desiccation  may  sometimes 
cause  dried  corpuscles  to  so  deviate  from  the  ordinary 
degree  of  contraction  during  that  process  (which,  accord- 
ing to  Carl  Schmidt,  is  a  constant  quantity,  '  the  drying 
of  blood  globules  of  different  animals,  isolated  or  in  mass, 
adhering  to  the  same  rule  of  evaporation  as  the  pollen  of 
a  flower,  and  the  coefficient  of  desiccation  in  all  of  them 
bearing  a  constant  relation  to  the  diminution  of  their 
volume')  as  to  lead  the  microscopist  who  relies  upon  the 
characteristic  of  magnitude  only  into  serious  or  fatal  error." 
But,  from  experiments  detailed  in  my  paper,  already  so 
largely  quoted,  it  will  be  seen  that  the  variation  in  the 
mean  diameters  of  blood  corpuscles  dried  under  various 
circumstances  did  not  amount  to  -j-j-oVrnF  of  an  inch.  It 
must  be  remembered,  however,  that  this  applies  only  to 
25* 


290  MEDICAL  MICROSCOPY. 

small  spots  of  blood,  and  possibly  may  not  hold  good  with 
large  quantities. 

"I  would  suggest  to  any  one  about  undertaking  such 
investigations  for  legal  purposes  that  he  first  accustom 
himself  to  the  appearance  of  decolorized  blood  corpuscles, 
and  at  the  same  time  test  the  power  of  his  microscope ; 
as  detailed  above  upon  a  fragment  of  blood  clot  recently 
dried  on  paper  or  glass,  coloring  the  outlines  by  means 
of  iodine  or  aniline  solution,  as  already  suggested,"  should 
he  find  greater  distinctness  required. 

If,  from  any  cause,  whether  it  be  want  of  sufficiently 
powerful  lenses,  or  too  advanced  disintegration  of  the  cor- 
puscles through  prolonged  exposure,  the  observer  fails  to 
succeed  in  his  efforts  for  the  recognition  of  red  blood  cor- 
puscles in  the  dried  clot,  he  may  resort  to  some  of  the 
methods  described  by  other  authorities  for  their  detection. 
Thus,  Dr.  Fleming  directs  that  specimens  of  dried  blood 
should  be  examined  by  placing  them  upon  a  slide  and 
cautiously  adding  water  in  quantity  proportioned  to  the 
size  of  the  stain,  so  as  to  make  a  close  imitation  of  the 
normal  serum ;  or,  as  very  ingeniously  suggested  by 
Bocker,  we  may  resort  to  the  use  of  serum  obtained  by 
filtering  human  or  other  mammalian  blood  in  the  exam- 
ination of  that  of  the  ovipara,  and  in  like  manner  may 
employ  the  serum  of  frogs'  blood  to  mix  with  that  having 
round  corpuscles.  Dr.  Alfred  S.  Taylor  recommends  that 
glycerin,  diluted  with  water  to  the  specific  gravity  of 
serum  (see  p.  3T),  should  be  used  to  soften  the  blood  clot, 
and  advises  it  not  only  on  account  of  the  ease  with  which 
it  may  be  obtained  pure,  but  also  of  the  slowness  with 
which  it  evaporates.  Albumen,  as  presented  in  the  white 
of  the  egg,  mixed  with  water  until  reduced  to  the  proper 
density,  has  been  found  free  from  many  objections  urged 
against  other  menstrua.  M.  Charles  Robin,  the  very  dis- 
tinguished Parisian  microscopist,  advises  that  a  solution  of 


STAINS   OF  BLOOD,  SPERMATIC  FLUID,  ETC.      291 

sulphate  of  soda  should  be  employed  for  moistening  sus- 
pected blood-stains,  claiming-  for  it  peculiar  advantages  in 
retaining  the  shape  and  size  of  the  red  disks. 

Pr.  Caspar  (Hand-Book  of  the  Practice  of  Forensic 
Medicine:  Sydenham  Society's  translation,  London,  1861) 
remarks  that  by  recent  discovery  microscopical  examina- 
tion permits  us  to  hope  that  we  may  be  able  to  recognize 
blood  by  its  aid,  even  when  the  quantity  is  much  too 
small  for  its  chemical  detection.  "  First  of  all,  we  must 
always  ascertain  the  existence  of  blood  corpuscles,  and  in 
satisfying  ourselves  of  this  we  must  not  neglect  the  white 
corpuscles,  since  their  detection  along  with  the  other  char- 
acteristics considerably  strengthens  the  credibility  of  the 
result.  In  treating  dried  stains  of  blood  in  the  usual  man- 
ner with  water,  watery  solutions  of  salt,  or  iodine,  etc., 
very  distinct  corpuscles  are  obtained.  If  many  of  these, 
however,  are  colorless,  the  probability  is  very  great  that 
it  is  purulent  ormuco-purulent  matter,  or  some  other  patho- 
logical product,  and  not  blood.  If  relatively  but  few  of 
the  corpuscles  are  colorless,  it  is  all  the  more  likely  to  be 
blood ;  the  discovery  of  fibrin  concludes  the  microscopic 
examination.  This  is  easily  recognized  as  the  material 
connecting  the  fragments  of  blood  after  they  have  been 
for  some  time  exposed  to  the  action  of  water."  This 
supposed  "  Fibrin"  probably  consists  in  reality  of  the 
cell-walls  of  the  decolorized  red  disks.  (See  page  176,  also 
Fig.  27.) 

MM.  Briand,  Chaude,  and  De  Claubry  (Manuel  complet 
de  Medecine  legale,  Paris,  1852,  page  789)  declare  that, 
"  however  great  may  be  the  age  of  the  spots,  microscopical 
examination  will  nevertheless  reveal  the  blood  globules ; 
those  on  which  M.  Robin  has  made  his  experiments  dated 
back  from  eight  to  twelve  years. 

"But,  in  order  that  the  micrographical  results  should 
be  positive,  it  is  necessary  that  the  spots  should  not  have 


292  MEDICAL  MICROSCOPY. 

been  washed,  or  that  the  tissues  on  which  they  have 
formed  should  not  have  been  placed,  while  the  stains  were 
fresh,  under  such  circumstances  that  putrefaction  could 
completely  alter  them  ;  for  it  is  evident  that  if  the  charac- 
teristic anatomical  elements  of  the  blood  are  destroyed,  it 
is  not  in  the  power  of  the  microscope  to  make  them  re- 
appear. Washing  destroys  the  globules,  but  leaves  their 
elements  conglomerated  in  such  a  way  that  we  can  find 
some  chemical  characters  when  the  microscopical  ones 
have  disappeared  ;  it  is  that  which  obliges  us  in  researches 
to  use  a  solution  of  sulphate  of  soda  instead  of  water  for 
moistening  the  spots. 

"After  having  cut  out  with  scissors  the  portions  of 
tissue  (linen,  hemp,  or  cotton)  to  be  examined,  we  place 
them  in  a  saturated  solution  of  this  salt,  in  which  we 
allow  them  to  remain  a  longer  or  shorter  time  according 
to  their  age. 

"  If  the  spots  are  recent  (for  example,  a  week  old),  three 
to  six  hours  are  sufficient  for  the  globules  to  become  sepa- 
rated ;  but  the  solution  is  only  imbibed  very  slowly  by 
fabrics  for  a  long  time  spotted,  and  those  which  date  back 
eight  or  twelve  years  require  three  or  four  days'  soaking. 

"When  the  stuff  is  completely  penetrated,  the  spots 
should  be  scraped  with  the  edge  of  a  scalpel  or  other 
similar  instrument,  and  the  reddish  liquid  from  them  de- 
posited upon  a  slide  and  covered  with  a  very  thin  glass." 
The  authors  state  that  we  find  fibers  of  the  tissue,  granu- 
lar matters,  and  a  great  number  of  microscopic  fungi,  to 
which  no  attention  need  be  paid,  while  the  blood  globules, 
of  which  the  majority  are  destroyed  by  drying,  constitute 
but  a  small  portion  of  the  objects  in  the  field ;  part  of 
the  globules  float  freely,  while  another  portion  adhere 
to  the  filaments  of  the  stuff.  Many  of  the  former  retain 
their  ordinary  size  and  discoid  shape,  although  some  have 
become  altered  in  their  contour.  Of  those  which  are 


OF  BLOOD,  SPERMATIC  FLUID,  ETC.     293 

adherent,  the  globules  which  occupy  the  edges  of  the 
groups  alone  show  their  regular  form,  while  the  others 
have  become  somewhat  polyhedral  during  desiccation. 
However,  the  mass  always  retains  a  peculiar  aspect,  which 
we  find  in  no  other  anatomical  element.  Should  it  be  a 
question  whether  the  blood  has  proceeded  from  a  mucous 
membrane,  as  in  a  case  of  rape,  the  spots  of  mucus  and 
the  epithelial  cells  become  important,  since  their  nature 
may  show  what  mucous  surface  has  been  wounded.  When, 
in  consequence  of  the  disintegration  of  the  globules  from 
age,  from  long  exposure  to  the  action  of  the  atmosphere, 
or  from  the  effects  of  moisture,  microscopical  research  fails 
to  reveal  any  of  the  corpuscular  blood  elements,  resort 
must  be  had  to  the  chemical  or  other  methods  of  detecting 
blood-stains.  Among  these,  one  of  the  most  important  is 
that  of  Teichmann  (Casper,  Op.  cit.,  page  199),  by  the 
formation  of  crystals  of  haemin,  which,  it  is  asserted,  will 
enable  us  to  diagnosticate  the  presence  of  blood,  no  matter 
what  its  condition,  and  although  the  fabric  upon  which 
the  stain  has  been  made  may  have  undergone  washing. 
"Biichner  and  Simon  have  indeed  proved  (by  this  method) 
the  existence  of  blood  in  a  small  rag  cut  from  a  butcher's 
slaughtering  trousers,  which  had  been  eight  years  in  use, 
but  had  not  been  worn  for  one  year  and  a  half  previously." 
The  following  is  substantially  their  simplified  process :  "A 
drop  of  blood,  or  fluid  containing  its  coloring  matter,  is  to 
be  mixed  in  a  watch-glass  with  an  excess  of  glacial  acetic 
acid  ;  it  is  then  to  be  slowly  evaporated  over  a  spirit  lamp, 
gas  jet,  in  a  sand-bath  or  oven  (or  spontaneously  in  the 
air).  When  the  dried  mass  is  now  brought  under  the 
microscope,  innumerable  crystals  of  haemin  are  at  once 
seen,  when  the  coloring-matter  of  the  blood  has  actually 
been  present  in  the  fluid  employed.  Sometimes  these 
crystals  are  isolated;  at  others,  and  more  usually,  they 
are  present  in  thousands.  These  crystals  are  rhomboidal 


294  MEDICAL  MICROSCOPY. 

in  form,  tabular,  or  otherwise ;  their  color  varies  from  a 
faint  yellowish  to  yellow  or  yellowish-red  or  a  dirty  blood- 
red  or  still  deeper  color ;  their  size  is  various,  and  they 
are  frequently  found  placed  over  one  another  in  a  cruci- 
form or  stellate  manner.  When  the  amount  of  blood  is 
very  small,  it  crystallizes  in  such  thin  tablets  and  cylin- 
ders that  they  appear  quite  colorless,  and  these  combine 
in  a  very  fine  reticular  form,  the  meshes  of  which  are 
extremely  close.  I  obtained  a  very  perfect  preparation  of 
this  nature  from  a  completely  faded  stain  from  menstrual 
blood,  the  size  of  a  cherry-stone,  which  for  three  months 
had  adhered  to  a  much  handled  piece  of  linen.  Stains  of 
blood  dried  upon  wood,  metal,  or  stuffs  are  most  rapidly 
tested  by  macerating  them  in  glacial  acetic  acid  in  a  test- 
tube  till  the  acid  is  colored,  and  then  evaporating  the 
fluid.  When  the  blood-stains  are  of  long  standing,  it  is 
better  to  boil  them  in  the  acid  in  a  test-tube  till  the  acid 
becomes  reddish,  and  then  evaporate  the  fluid." 

Among  the  chemical  and  physical  characteristics  by 
which  blood-stains  are  distinguished  from  those  produced 
by  other  substances  are  the  following,  as  detailed  by  Dr. 
Fleming  (Blood-Stains  in  Criminal  Trials,  Pittsburg, 
1861,  page  11): 

"1.  They  are  soluble  in  distilled  water,  and  impart  to  it 
a  beautiful  red  color,  more  or  less  intense  as  the  propor- 
tion of  the  size  of  the  stain  and  water  vary,  of  a  very 
feeble  alkaline  reaction,  changing  the  red  litmus  to  blue. 

"2.  When  ammonia  is  added  to  the  aqueous  solution, 
no  change  takes  place  in  the  color,  but  an  alteration  from 
red  approaching  to  brown  is  found  in  proportion  to  the 
degree  of  concentration  of  the  ammonia. 

"  3.  When  the  solution  is  heated,  coagulation  takes  place, 
the  bright  red  color  is  destroyed,  and  grayish  flocculi  are 
found. 

"  4.  These  floccuji  are  quickly  dissolved  by  a  solution 


STAINS  OF  BLOOD,  SPERMATIC  FLUID,  ETC.     295 

of  potassa,  and  the  liquid  assumes  a  green  tint  by  reflected 
and  red  by  transmitted  light ;  the  dichroism  produced  in 
this  man  HIT,  according  to  M.  Gaultier  de  Claubry,  is  a  cer- 
tain indication  of  the  presence  of  blood  (which  Caspar, 
Op.  cit,  page  198,  however,  denies).  When  the  solution 
is  very  dilute,  to  produce  this  phenomenon  an  advantage 
will  be  found  in  using  caustic  potassa. 

"  5.  Blood-stains  are  insoluble  in  alcohol,  ether,  and  oils. 

"  6.  Driej^  blood  is  slowly  soluble  in  strong  sulphuric 
and  muriatic  acids,  forming  dark-brown  solutions  ;  it  is 
more  rapidly  acted  upon  by  nitric  acid,  which  dissolves  it 
with  effervescence." 

The  reader  is  referred  to  Dr.  Fleming's  able  treatise 
quoted  above  for  a  full  description  of  the  methods  for  test- 
ing blood-stains  by  the  detection  of  their  contained  iron, 
as  suggested  by  Runge  and  Berghauss;  by  the  Haematal- 
loscopy  of  M.  Taddei  of  Florence,  and  by  the  recognition 
of  a  specific  odor  announced  as  very  characteristic  by  M. 
Barruel  in  1829,  but  not  confirmed  by  subsequent  ob- 
servers. 

The  same  author  narrates  the  following  very  interesting 
case  as  exhibiting  the  value  which  a  complete  microscopical 
examination,  not  merely  of  blood-stains,  but  of  other  sus- 
pected matters,  may  have  in  the  detection  of  crime.  The 
trial  occurred  at  Norwich,  England,  about  the  year  1850, 
under  these  circumstances:  "A  female  child,  nine  years 
old,  was  found  lying  on  the  ground  in  a  small  plantation, 
quite  dead,  with  a  large  and  deep  gash  in  the  throat.  Sus- 
picion fell  upon  the  mother  of  the  murdered  girl,  who, 
upon  being  taken  into  custody,  behaved  with  the  utmost 
coolness,  and  admitted  having  taken  her  child  to  the  plan- 
tation where  the  body  was  found,  whence  the  child  was 
lost  in  quest  of  flowers.  Upon  being  searched,  there  was 
found  in  the  woman's  possession  a  large  and  sharp  knife, 
which  was  at  once  subjected  to. a  minute  and  careful  exam- 


296  MEDICAL  MICROSCOPY. 

ination.  Nothing,  however,  was  found  upon  it,  with  the 
exception  of  a  few  pieces  of  hair  adhering  to  the  handle, 
so  exceedingly  small  as  scarcely  to  be  visible.  The  exam- 
ination being  conducted  in  the  presence  of  the  prisoner, 
and  the  officer  remarking,  'Here  is  a  bit  of  fur  or  hair  on 
the  handle  of  your  knife,'  the  woman  immediately  replied, 
'  Yes,  I  dare  say  there  is,  and  very  likely  some  stains  of 
blood,  for  as  I  came  home  I  found  a  rabbit  caught  in  a 
snare,  and  cut  its  throat  with  the  knife.'  The  knife  was 
sent  to  London,  and,  with  the  particles  of  hair,  subjected 
to  a  microscopic  examination.  No  trace  of  blood  could  at 
first  be  detected  upon  the  weapon,  which  appeared  to  have 
been  washed ;  but  upon  separating  the  horn  handle  from 
its  iron  lining  it  was  found  that  between  the  two  a  fluid 
had  penetrated  which  turned  out  to  be  blood, — certainly 
not  the  blood  of  a  rabbit,  but  bearing  every  resemblance  to 
that  of  the  human  body.  The  hair  was  then  submitted  to 
examination.  Without  knowing  anything  of  the  facts  of 
the  case,  the  microscopist  immediately  declared  the  hair 
to  be  the  hair  of  a  squirrel.  Now,  round  the  neck  of  the 
child  at  the  time  of  the  murder  there  was  a  tippet  or  '  vic- 
torine,'  over  which  the  knife,  by  whomever  held,  must 
have  glided  ;  and  this  victorine  was  of  squirrel's  fur  ! 

"  This  strong  circumstantial  evidence  of  the  guilt  of  the 
prisoner  was  deemed  by  the  jury  sufficient  for  a  conviction, 
and  whilst  awaiting  execution  the  wretched  woman  fully 
confessed  her  crime." 

Within  the  last  few  years  the  detection  of  blood-stains 
by  spectrum  analysis  applied  to  the  microscope  has  at- 
tracted a  good  deal  of  attention  through  the  researches,  in 
great  measure,  of  Mr.  H.  C.  Sorby  (Quarterly  Journal 
of  Science,  April,  1865,  vol.  ii.  page  198,  and  Beale,  How 
to  Work  with  the  Microscope,  London,  1868,  page  218), 
who  maintains  that  they  can  be  recognized  by  this  method 
with  great  ease  and  certainty,  even  when  in  very  minute 


STAINS  OF  BLOOD,  SPERMATIC  FLUID,  ETC.      297 

quantity.  His  general  plan  of  operation  is  founded  upon 
the  well-known  fact,  that  different  solutions  through  which 
the  solar  spectrum  is  passed  absorb  different  portions  of 
its  constituent  colors,  and  hence  give  rise  to  dark  lines 
situated  in  the  red,  violet,  blue,  etc.  It  is  obvious  that  by 
testing  solutions  of  supposed  blood-stains,  first  in  pure 
water  and  subsequently,  after  the  reaction  of  sulphite  of 
soda,  ammonia,  citric  acid,  etc.  (which  are  found  by  experi- 
ment to  alter  or  destroy  the  absorption  bands  produced  by 
certain  substances,  without  affecting  those  caused  by 
others),  we  have  within  our  power  a  very  complete  and 
delicate  method  for  detecting  blood-stains;  for  the  full  de- 
tails of  the  process  I  must,  however,  refer  my  readers  to 
the  articles  above  mentioned,  and,  unfortunately,  since  the 
method,  so  far  as  hitherto  investigated,  offers  no  prospect 
of  enabling  us  to  distinguish  between  the  blood  of  different 
animals,  it  can  only  be  of  service,  as  corroborative  evi- 
dence, when  the  corpuscular  elements  are  still  recognizable 
in  the  stain. 

As  a  very  delicate  test  for  blood-stains,  Dr.  Alfred  S. 
Taylor  recommends  their  reaction  with  tincture  of  guaiacum 
and  the  peroxide  of  hydrogen,  and  in  Guy's  Hospital  Re- 
ports for  1870,  vol.  xv.,  third  series,  p.  273,  Dr.  Taylor 
further  states  that  Dr.  John  Day,  of  Geeloug,  Australia, 
has  improved  upon  his  process  above  referred  to  by  em- 
ploying ozonized  or  ozonic  ether  in  place  of  the  watery 
solution  of  peroxide  of  hydrogen,  which  is  apt  to  become 
acid,  and  then  interferes  with  the  reaction  sought ;  he  re- 
marks that  he  has  had  to  make  use  of  this  process  in  many 
cases,  since  the  date  of  his  former  paper,  and  has  found 
that,  under  proper  precautions,  the  results  are  most  satis- 
factory. "  The  coloring-matter  of  blood  could  be  detected 
in  cases  in  which  the  microscope  and  the  ordinary  means 
of  research  failed  to  show  its  presence."  (?) 

26 


298  MEDICAL  MICROSCOPY. 

Mr.  H.  C.  Sorby  also  furnishes  in  the  same  article  some 
directions  for  the  Detection  of  Blood  by  means  of  the  spec- 
trum microscope,  which,  however,  require  certain  explana- 
tions, given  in  Beale's"  How  to  Work  with  the  Microscope," 
to  which  I  have  referred.  Although  this  method  of  detect- 
ing blood-stains  is,  it  seems  to  me,  less  delicate  than  the  one 
I  have  pointed  out,  and  admittedly  inferior  to  the  latter  as 
a  means  .of  deciding  the  important  question  as  to  what 
animal  the  blood  is  derived  from,  Mr.  Sorby  informs  us 
that  the  two  well-marked  absorption  bands  in  the  green 
produced  in  the  spectrum  passed  through  the  solution 
of  blood  from  a  fresh  stain  become  fainter,  while  another 
band  appears  in  the  red  whose  relative  distinctness  shows 
the  amount  of  change,  and  is  some  indication  of  the  age  of 
the  stain,  a  point  which  may  be  occasionally  of  great 
importance  in  medico-legal  investigations,  and  to  which 
no  other  method  of  research  that  I  am  acquainted  with 
affords  a  clue. 

In  the  trial  of  George  S.  Twitchell  for  the  murder  of  his 
mother-in-law  (Philadelphia,  1»68),  an  effort  was  made  to 
raise  the  question  whether  certain  stains  were  not  produced 
by  the  splashing  of  bloody  water;  and  from  some  experi- 
ments I  made  to  test  this  point  I  conclude  that  "the  dis- 
covery in  the  fluid  from  a  blood-stain  (treated  with  diluted 
glycerin)  of  numerous  rounded  and  oval  corpuscles,  granu- 
lar to  a  greater  or  less  degree,  and  which  swell  up  exhibit- 
ing one,  two,  or  three  nuclei  on  the  free  addition  of  water, 
would,  in  my  opinion,  justify  the  microscopist  in  affirming 
that  the  spot  had  been  caused  by  undiluted  or  but  slightly 
diluted  blood."  See  Medical  and  Surgical  Reporter,  Phila- 
delphia, Jan.  8,  1869. 

The  investigation  of  stains  upon  clothing  supposed  to  be 
caused  by  spermatic  fluid,  as  in  cases  of  rape,  indecent 
assault,  etc.,  is  sometimes  of  very  great  importance,  and 
demands  the  most  skillful  and  accurate  manipulation;  while 


STAINS  OF  BLOOD,  SPERMATIC  FLUID,  ETC.      299 

its  success  is  much  facilitated  by,  if  not  largely  dependent 
upon,  the  employment  of  high  powers,  e.g.  the  -fe  and  ^ 
objectives. 

In  a  case  upon  which  I  was  consulted  some  time  since, 
where  a  young  girl  was  said  to  have  been  violated  by  main 
force  and  held  down  for  some  minutes  subsequently,  the 
chemise  worn  on  the  occasion  was  brought  to  me  for  ex- 
amination. On  inspection,  besides  sundry  small  reddish 
spots  and  streaks  upon  the  front,  there  were  to  be  seen  two 
large  stains  on  either  side  of  the  middle  of  the  back  of  the 
garment,  each  about  four  inches  long  by  three  inches  wide, 
such  as  might  occur  from  any  fluid  running  down  the  inside 
of  the  thighs  from  the  vulva  of  a  female  lying  upon  her 
back  in  a  nearly  horizontal  posture.  My  first  duty  being 
obviously  to  determine  whether  these  reddish  stains  were 
produced  by  blood,  the  chemise  was  doubled  over  at  the 
most  highly  tinted  part  of  one  spot,  and  the  convex  portion 
of  the  fold  scraped  lightly  with  a  sharp  scalpel  over  a  clean 
slide  until  a  small  quantity  of  fine  reddish  dust  was 
obtained.  This  powder  was  covered  with  thin  glass,  and,  a 
drop  of  water  being  applied  to  one  edge,  and  a  fragment  of 
bibulous  paper  to  the  other,  a  current  of  fresh  fluid  was 
kept  up  for  about  one  minute  (see  page  285),  when  the 
specimen  was  examined  with  a  power  of  1200  diameters. 
Among  the  numerous  fragments  of  cotton  fibers,  and  in 
many  cases  attached  to  these,  were  to  be  seen  whitish  trans- 
parent masses,  composed  of  very  faintly  outlined  rounded 
and  oval  cells  closely  aggregated  together,  and  evidently 
deformed  by  mutual  pressure,  while  here  and  there  appeared 
granular  rounded  or  oval  bodies,  somewhat  larger  and  less 
distorted  in  their  aspect.  (See  Fig.  21.)  Both  these  cel- 
lular elements  became  more  clearly  visible  when  slightly 
tinted  with  aniline,  and  on  measurement  with  the  microm- 
eter were  found  to  average  about  ^Vo"  an(^  Woir  °f  an 
inch  in  diameter  respectively,  whence  I  concluded  that  the 


300  MEDICAL   MICROSCOPY. 

red  stains  were  produced  by  blood,  probably  that   of  a 
human  being. 

On  careful  consideration  of  the  general  aspects  of  the 
case,  it  seemed  to  me  that  the  supposition  of  willful  de- 
ception, which  the  presence  of  vaginal  epithelium  in  the 
scrapings,  and  also  in  the  washings  subsequently  examined 
(without  cells  from  the  uterine  mucous  membrane,  as  would 
have  been  the  case  had  menstrual  blood  been  ingeniously 
used  to  produce  spots  voluntarily  made  for  the  purpose 
of  substantiating  a  false  charge),  rendered  very  improb- 
able, might  be  put  aside.  The  main  question,  as  to  the 
presence  or  absence  of  spermatozoa,  still  continuing 
unsolved,  as  none  had  been  detected  among  the  particles 
of  blood-clot,  a  fragment  of  muslin  about  three-fourths  of 
an  inch  long  by  one-eighth  of  an  inch  wide,  selected  from  a 

FIG.  28. 


FRAGMENTS  OF  SPERMATOZOA,  from  Stain  upon  a  Chemise  in  case  of  supposed  Rape. 
X  2800  Diameters  (l-50th). 

portion  where  the  fabric  although  but  little  stained  was  a 
good  deal  stiffened  by  the  suspected  material,  was  cut  out 


STAINS  OF  BLOOD,  SPERMATIC  FLUID,  ETC.     301 

with  a  pair  of  curved  scissors,  and,  after  soaking  for  a  couple 
of  minutes  in  a  drop  or  two  of  weak  glycerin  and  water 
(p.  37),  its  inner  surface  was  gently  scraped  and  pressed 
with  a  scalpel,  the  visible  filaments  of  cotton  picked  out 
with  a  mounted  needle,  the  remainder  covered  with  a  very 
thin  glass  and  subjected  to  examination  under  a  Powell 
and  Lealand's  -5^,  giving  a  power  of  about  2800  diameters. 
Several  indubitable  spermatozoa,  nearly  all,  however, 
more  or  less  broken,  as  will  be  seen  by  reference  to  Fig. 
28,  were  readily  detected,  and  proved  beyond  all  question 
that  spermatic  fluid,  mingled  with  blood,  had  caused  the 
stains  upon  the  chemise.  The  spermatozoon  on  the  right 
of  the  drawing,  represented  as  lying  upon  its  side,  appeared 
to  have  been  in  great  measure  protected  by  its  attachment 
to  a  squamous  epithelial  cell,  probably  from  the  vagina. 

Dr.  Caspar,  in  his  Hand-Book  of  the  Practice  of  Foren- 
sic Medicine,  vol.  i.,  Sydenham  Society's  translation,  Lon- 
don, 1861,  recommends  for  the  investigation  of  stains  of 
semen  the  method  of  Koblauk,  as  at  once  the  best  and 
simplest.  "A  piece  of  the  linen  containing  the  suspected 
spot  is  cut  out  and  placed  in  a  porcelain  saucer  containing 
a  few  drops  of  cold  distilled  water;  the  linen  is  then  to  be 
thoroughly  and  carefully  moistened  by  gentle  and  careful 
pressure  and  moving  about  with  a  glass  rod ;  after  a  quarter 
of  an  hour  a  single  drop  of  the  water  is  to  be  gently 
squeezed  by  the  finger  from  the  linen  upon  a  clean  glass 
slide,  and,  should  the  stain  have  been  truly  seminal,  the 
zoosperms  will  be  at  once  readily  recognized  on  bringing 
the  slide  under  the  microscope.  Inexperienced  persons 
may  no  doubt  be  deceived  by  the  presence  of  epithelial  cells, 
the  fibers  of  the  linen,  etc.,  but  whoever  has  only  once  seen 
a  single  characteristic  spermatozoon,  dead  or  alive,  can 
never  be  deceived  again.  I  have  recognized  them  even 
after  the  lapse  of  an  entire  year,  and  thereby  determined 
the  existence  of  a  seminal  stain.  Bayard  states  that  he 

26* 


302  MEDICAL  MICROSCOPY. 

has  recognized  them  after  three  years,  and  Hitter  even 
after  four  years,  which  is  perfectly  credible,  presupposing 
always  that  the  linen  during  that  long  time  has  not  been 
much  rubbed  or  handled,  because  the  forms  of  thezoosperms 
will  be  thereby  destroyed.  After  a  considerable  time 
indeed  they  fall  to  pieces  of  themselves,  and  then  nothing 
is  commoner  than  to  find  only  mutilated  specimens,  heads, 
and  filaments  separate ;  but  one  single  perfect  zoosperm 
gives  complete  certainty  as  to  the  actual  presence  of  a 
seminal  stain.  If  the  careful  examination  of  an  experienced 
eye  has  failed  in  detecting  a  single  animalcule,  after  re- 
peated examination,  the  medical  jurist  must  declare  that, 
whatever  may  be  the  probabilities,  no  evidence  exists  to 
prove  that  the  stain  examined  has  been  caused  by  semen." 

To  these  very  judicious  remarks  of  Dr.  Caspar  I  may 
add  that  the  appearance  of  spermatozoa  under  a  high  ob- 
jective (much  more  powerful  than  any  in  existence  at  the 
time  he  wrote)  is  so  very  characteristic  that  I  should  have 
no  hesitation  in  pronouncing  that  stain  a  seminal  one  in 
which  I  could  detect  two  heads  of  spermatozoa  (Fig.  28), 
with  only  a  fourth  part  of  their  tails  attached,  even  though 
no  complete  specimen  could  be  found.  I  would  suggest 
that  any  one  undertaking  such  a  research  should  acquaint 
himself  with  the  appearances  broken  spermatozoa  present 
when  moistened  with  glycerin  and  water  after  desiccation, 
by  preparing  a  few  spots  upon  muslin  with  drops  of  deposit 
from  urine  containing  spermatozoa  (see  Chapter  IV.  p.  99), 
and  then  testing  fragments  cut  out  as  above  described. 
Novices  may  find  it  advantageous  to  add  a  drop  of  aniline 
solution,  as  advised  on  p.  45,  and  by  thus  tinting  the 
spermatozoa  (see  Fig.  8)  insure  their  recognition. 

MM.  Briand,  Chaude,  and  De  Claubry,  in  their  Manuel 
Complet  de  Medecine  Legale,  Paris,  1852,  p.  807,  mention 
sundry  chemical  tests  for  seminal  stains,  and  recommend 
the  following  method  for  the  detection  of  spermatozoa: 


t 

STAINS  OF  BLOOD,  SPERMATIC  FLUID,  ETC.      303 

"  One  should  macerate  threads  of  the  tissue  in  distilled 
water  for  twenty-four  hours,  taking  care  not  to  rub  them, 
and  filter  the  liquor  ;  the  tissue  should  then  be  again  im- 
mersed in  wutiT,  which  must  be  heated  to  a  temperature 
of  60°  to  70°  Cent,  and  also  filtered ;  finally,  the  fabric 
should  be  treated  with  a  weak  solution  of  alcohol,  or  with 
water  to  which  a  little  ammonia  has  been  added,  and  again 
throw  it  upon  the  filter.  All  these  products  having  been 
thus  treated,  the  filter  containing  their  solid  ingredients  is 
removed,  about  an  inch  of  its  point  is  to  be  cut  off,  and, 
being  opened  out,  spread  face  downward  upon  a  watch- 
glass,  or  in  a  little  flat  cup  such  as  is  often  used  with  the 
microscope,  when  it  is  to  be  soaked  again  with  alcohol  and 
water,  or  a  solution  of  ammonia,  which  dissolves  the 
mucus.  After  a  short  time  we  may  carefully  raise  up  the 
paper,  which  leaves  upon  the  glass  the  zoosperms  and  all 
the  substances  which  may  be  insoluble  in  the  menstrua 
employed,  and  if  these  include  only  oil  globules,  we  may 
cause  them  to  disappear  by  the  addition  of  a  little  ether." 
This  mode  of  examination  is  of  course  most  applicable  to 
instances  where  a  stain  or  stains  of  considerable  size  are 
at  the  disposal  of  the  microscopist ;  although  much  more 
intricate  than  the  plan  described  previously,  it  may  some- 
times be  used  to  advantage  in  cases  where,  the  chief  evi- 
dence being  circumstantial,  the  corroboration  of  a  variety 
of  methods  is  required. 

The  medical  jurist  may  occasionally  be  required  to  give 
an  opinion  as  to  whether  specimens  of  spermatozoa  he  has 
detected  are  really  those  of  man,  and  not  testicular  prod- 
ucts of  some  other  animal,  employed  for  the  purpose  of 
deception.  Under  such  circumstances  accurate  measure- 
ments would  be  very  important,  and  since  these  differ  in 
the  different  species  of  mammals,  and  still  more  in  birds, 
fishes,  etc.,  they  would  probably  be  conclusive.  Of  course, 
counsel  propounding  such  a  theory  to  account  for  a  suspi- 


304  MEDICAL  MICROSCOPY. 

eious  stain  proved  to  contain  spermatozoa  should  right- 
fully be  compelled  to  show  some  probability  of  access  to 
the  one  of  the  inferior  animals  from  which  they  could  be 
presumed  to  be  derived.  Of  these  the  more  likely  are 
perhaps  the  dog,  whose  spermatozoa  as  figured  by  Rudolph 
Wagner  (Elements  of  Physiology,  translated  by  Robert 
Willis,  M.D.,  London,  1844,  p.  11)  are  about  one-fourth 
larger  than  those  of  man,  and  have  the  body  broadest  at 
the  extremity,  instead  of  at  the  base ;  that  of  the  rabbit, 
in  which  the  body  is  nearly  twice  the  size  of  the  same 
part  of  a  human  spermatozoon,  etc.  The  seminal  ani- 
malcules of  the  monkey  tribe  closely  resemble  those  of 
man,  but  are  about  one-half  larger.  Professor  Dalton 
states  (Human  Physiology,  Philadelphia,  1858,  p.  458): 
"  The  spermatozoa  of  the  human  subject  are  about  g^  of 
an  inch  in  length,  according  to  the  measurements  of  Kol- 
liker.  *  *  *  The  head  constitutes  about  one-tenth 
part  the  entire  length  of  the  spermatozoon. " 

The  important  subject  of  the  detection  of  poisons  in  very 
minute  quantities  by  reactions  which  are  so  slight  as  to  be 
quite  imperceptible  to  the  naked  eye,  although  distinctly 
visible  under  the  microscope,  has  been  very  fully,  indeed, 
almost  exhaustively,  investigated  by  Prof.  Theodore 
Wormley,  of  Starling  Medical  College,  Ohio,  in  his  elab- 
orate work  on  the  Micro-Chemistry  of  Poisons,  New  York, 
1869,  in  which  methods  for  the  recognition  of  the  j^^nnr 
of  a  grain  of  Arsenious  acid  by  the  discovery  of  its  octa- 
hedral crystals  with  a"  power  of  150  diameters,  also  of 
the  same  infinitesimal  quantity  of  hydrocyanic  acid  by 
the  formation  of  microscopic  crystals  of  cyanide  of  silver, 
are  specifically  described  ;  to  it  the  reader  is  referred,  with 
full  confidence  that  it  will  supply  abundant  information  in 
regard  to  the  matters  of  which  it  treats. 


CHAPTER    XV. 

HINTS     IN     REGARD     TO     THE     EXAMINATION     OF     MORBID 
GROWTHS. 

WHILST  a  large  number  of  the  examinations  of  patho- 
logical formations  in  the  human  organism,  coming  as  they 
do  under  the  department  of  post-mortem  researches,  instead 
of  investigations  where  the  microscope  is  called  upon  to 
render  assistance  in  the  "  diagnosis,  prognosis,  or  treat- 
ment of  disease,"  do  not  therefore  constitute  a  part  of 
Medical  Microscopy  in  its  strictest  sense,  yet  as,  in  addi- 
tion to  those  cases  where  a  prognosis  after  operation  not 
proving  mortal  is  demanded,  instances  frequently  are  pre- 
sented where  great  satisfaction  may  be  given,  not  only  to 
the  physician  but  also  to  the  family  and  friends  of  a 
deceased  person,  by  the  positive  determination  of  the  pres- 
ence or  absence  of  malignant  disease,  I  will  endeavor 
very  briefly  to  indicate  some  of  the  rules  which  may  best 
guide  us  towards  a  satisfactory  completion  of  this  duty  to 
the  survivors. 

Since,  by  the  labors  of  Yirchow  and  others  of  his 
school,  the  doctrine  of  Lebert,  who  taught  the  existence  of 
specific  "cancer-cells"  always,  and  only,  to  be  found  in  cases 
of  cancerous  disease,  has  been  overthrown,  it  becomes  a 
matter  of  necessity  that  the  results  of  microscopic  investi- 
gation shall  be  considered,  not  as  absolute  proofs,  but  only 
as  important  data,  which,  when  carefully  weighed  in  con- 
junction with  the  naked-eye  appearances,  the  seat  of  the 
affection  and  its  mode  of  development,  the  constitutional 

(305) 


306  MEDICAL  MICROSCOPY. 

symptoms,  history,  and  circumstances  of  the  patient,  etc., 
will  generally  enable  as  to  arrive  at  a  correct  conclusion. 
I  say  generally,  because  I  freely  admit  that  there  are  some 
cases  which  I  am  not  able  to  determine,  and  firmly  believe 
that  instances  occasionally  occur  whose  nature,  with  our 
present  knowledge,  it  is  utterly  beyond  the  power  of  any 
microscopist  to  decide.  On  the  other  hand,  however,  the 
student  can  comfort  himself  with  the  assurance  that  he 
will  meet  with  numerous  examples  of  malignant  and  non- 
malignant  growths,  where,  with  ordinary  care  and  atten- 
tion, he  may  with  confidence  promptly  answer  the  ques- 
tions propounded  to  him ;  and  just  as  he  gains  more  ex- 
perience in  the  work  and  becomes  more  skillful  in  the  use 
of  his  microscope  will  the  proportion  of  insoluble  problems 
diminish,  until  their  number  becomes  very  small  indeed. 

When  a  morbid  growth,  or  a  formation  suspected  of 
being  such,  is  offered  to  us  for  examination,  if  it  is  either  a 
tumor  removed  during  life  or  a  post-mortem  specimen,  we 
may  proceed,  first,  to  select  some  portion  of  the  structure 
in  which  its  characteristic  peculiarities,  as  estimated  by 
the  naked-eye  appearances,  are  best  developed ;  and  this 
will  generally  be  found  in  the  central,  as  the  oldest,  part 
of  the  tumor,  except  where  this  has  advanced  to  the  stage 
of  fatty  degeneration  (with  or  without  the  formation  of 
pus),  in  which  case  better  results  will  be  obtained  by  in- 
vestigation of  specimens  chosen  from  the  more  peripheral 
regions  of  the  growth.  Sections  cut  from  the  outskirts  of 
the  tumor  often  yield  only  negative  results,  for,  as  re- 
marked by  Yirchow  (Cellular  Pathology,  translated  by 
Chance,  Phila.  reprint,  1863,  p.  498),  "  There  is  a  stage 
when  it  is  impossible  to  decide  with  certainty  whether  we 
have  in  a  part  to  deal  with  simple  processes  of  growth, 
or  with  the  development  of  a  heteroplastic  destructive 
growth." 

In  order  to  judge  of  a  suitable  point  for  investigation, 


EXAMINATION  OF  MORBID   GROWTHS.         SO  7 

as  suggested  above,  two  or  three  incisions  should  be  made 
into  the  substance  of  the  tissue,  and  from  the  one  deter- 
mined upon  a  small  portion  of  the  fluid  or  "juice"  (if  any) 
which  exudes  upon  the  cut  surface,  or  can  be  made  to 
appear  by  scraping  and  pressing  that  surface  with  the  edge 
of  a  sharp  scalpel,  should  be  removed  upon  the  knife- 
blade,  deposited  upon  a  slide,  covered  with  thin  glass,  and 
submitted  to  examination  first  beneath  a  power  of  about 
200,  and  afterwards  with  higher  objectives.  The  amount 
and  character  of  the  juice,  as  it  flows  out  beneath  the  knife, 
should  be  carefully  noted,  since,  as  will  be  detailed  further 
on,  much  stress  is  placed  by  some  authorities  upon  its 
scarcity  or  abundance.  Should  the  tumor  be  so  dry  and 
juiceless  that  more  fluid  is  required  to  moisten  the  scrap- 
ings of  the  cut  surface,  resort  should  be  had  to  weak  syrup 
or  glycerin  and  water  of  1028  sp.  gr.  (p.  37),  in  order  to 
avoid  altering  the  form  of  any  cellular  elements  which  may 
be  present.  After  a  careful  examination  of  specimens 
under  these,  as  far  as  possible,  normal  conditions,  a  very 
small  drop  of  acetic  acid  may  be  applied  at  one  edge  of  the 
cover,  and  allowed  to  act  upon  the  cells  as  it  flows  in 
among  them,  the  fact  of  its  entrance  being  verified  by  ob- 
serving cells  whirled  along  in  the  currents,  and  by  see- 
ing it  cause  the  ordinary  changes  in  the  Leucocytes  (see 
page  160,  also  Fig.  10).  A  small  drop  of  aniline  solution 
should  then  be  introduced  at  the  opposite  edge  of  the 
covering  glass,  and  its  effects  upon  the  structures  under 
investigation  (defining  cell-walls,  bringing  into  view  nuclei 
and  nucleoli,  etc.)  likewise  carefully  observed.  If,  as 
often  happens,  small  globules  resembling  oil  drops  (Fig. 
14)  puzzle  the  microscopist  with  the  suspicion  that  they 
may  be  fungi,  altered  blood  disks,  etc.,  they  should  be 
tested  by  sulphuric  ether,  which  can  be  best  applied  to  the 
margin  of  the  covering  glass  by  means  of  a  tube  pipette 
with  an  unusually  fine  capillary  opening;  but  so  volatile 


308  MEDICAL  MICROSCOPY. 

is  this  reagent  that  much  experience  in  its  use  is  generally 
necessary  before  the  observer  can  retain  any  small  floating 
object  in  the  field  of  view,  whilst,  on  the  other  hand,  be- 
ginners are  apt  to  imagine  that  Ether  has  no  effect  upon  the 
globules  before  them,  when  the  fact  is  the  ethereal  current 
has  quite  failed  to  reach  the  portion  of  the  slide  beneath 
the  objective. 

After  the  fluids  of  the  tumor  and  their  contained  cellular 
elements  have  been  rigidly  inspected,  the  investigation 
should  be  concluded  by  the  examination  of  thin  sections 
cut  from  various  portions  of  the  growth,  some  of  which 
should  comprise  the  margins  of  the  pathological  formation, 
and,  if  possible,  extend  into  the  normal  tissues  adjacent ; 
and  since  this  difficulty  of  cutting  slices  thin  enough  is 
one  of  the  greatest  obstacles  in  the  way  of  the  young 
microscopist,  some  particular  directions  may  not  be  unac- 
ceptable. I  think  that  one  of  the  chief  causes  of  the  stu- 
dent's want  of  success  is  that  he  tries  to  prepare  his 
sections  too  large,  forgetting  that  the  merest  fragment 
(absolutely  not  larger  than  this  note  of  exclamation, !) 
will,  when  magnified  200  times,  fill  several  fields  of  view 
and  prove  quite  sufficient  to  reveal  the  structure  of  a 
growth.  In  tissues  not  softer  than  an  ordinary  kidney,  I 
would  therefore  recommend  that  the  observer,  having 
provided  himself  with  a  sharp  razor  or  scalpel,  should 
prepare  a  small  parallelopipedon  of  tumor  substance  about 
half  an  inch  long,  a  quarter  of  an'inch  wide,  and  one-eighth 
of  an  inch  thick,  which  may  be  held  firmly  between  the 
finger  and  thumb  of  the  left  hand  (in  a  fold  of  muslin 
if  preferred  by  a  tyro),  while  a  thin  wedge  is  cut  from 
one  of  its  edges  with  the  razor  previously  wetted  with 
glycerin  and  water  or  weak  syrup.  This  wedge  should 
be  turned  round  upon  the  blade  of  the  razor  with  a 
mounted  needle,  and  then  drawn  gently  off  (of  course  by 
its  thicker  extremity  or  head)  on  to  a  slide,  where  its  thin 


EXAMINATION  OF  MORBID   GROWTHS.         309 

edge  is  to  be  floated  out  in  a  drop  of  fluid,  cut  off  by  a 
scalpel  applied  perpendicularly,  so  as  not  to  disturb  the 
relations  of  its  parts,  and  covered  with  an  ordinary  glass 
film  ready  for  examination.  As  I  have  seen  a  student 
prepare  in  this  way,  after  a  few  trials,  sections  thin  enough 
even  for  my  -fa,  I  cannot  but  hope  that  it  will  prove  gener- 
ally feasible,  and  contribute  to  do  away  with  one  of  the 
great  difficulties  in  the  path  of  the  juvenile  microscopist. 
Of  course,  as  experience  is  gained,  larger  and  larger  sections 
can  be  cut,  and,  as  in  other  affairs  of  life,  "the  little  end  of 
the  wedge"  will  no  longer  be  the  chief  object  of  solicitude. 
For  soft  tissues  we  resort  to  Strieker's  method  of  "  Em- 
bedding," by  placing  the  structure  in  a  little  folded  paper 
tray,  pouring  over  it  melted  wax  and  oil  (equal  parts), 
and  when  cold  cutting  thin  slices  of  the  compound  mass 
held,  if  preferred,  in  a  section  cutter,  such  as  Beale  figures  ; 
or  "tease"  out  a  fragment  with  mounted  needles;  or  wait 
some  days,  until  by  soaking  in  strong  alcohol,  or  in 
chromic  acid  solution  (2  gr.  to  the  ounce)  the  structures 
we  wish  to  examine  have  become  sufficiently  hardened 
to  bear  the  pressure  of  the  razor's  edge.  In  the  mode- 
rately soft  tumors  we  can  sometimes  snip  off,  with  a 
pair  of  curved  scissors,  such  as  are  used  by  oculists  in 
operations  for  Entropion,  a  little  wedge-shaped  fragment, 
whose  side  or  edge  may  be  thin  enough  for  our  purpose. 
As  a  general  rule,  the  section  for  examination  should  not 
be  thicker  than  ordinary  writing-paper,  while  for  the 
higher  powers  much  more  delicate  films  are  required.  I 
am  informed  by  my  friend  Dr.  Wm.-B.  Corbit,  of  this  city, 
that  the  method  now  in  use  in  Prof.  Rokitansky's  Labora- 
tory in  Vienna  is  to' place  a  small  fragment  of  the  soft 
tissue,  from  which  a  section  is  desired,  between  two  flat 
strips  of  elder-pith  (as  lateral  supports)  in  a  "clamp"  (a 
small  hand-vise),  and,  after  screwing  this  up  firmly,  to  cut 
thin  slices  of  pith  and  all  from  the  part  left  projecting  above 

27 


310  MEDICAL  MICROSCOPY. 

the  jaws  of  the  instrument,  each  slice  being  subsequently 
floated  off  the  blade  of  the  knife  or  razor,  and  spread  out 
upon  a  slide,  whence  the  particles  of  pith  should  be  re- 
moved by  needles. 

After  obtaining  a  suitable  section,  its  examination 
should  be  conducted  in  the  manner  directed  above  for  the 
investigation  of  the  fluid  matters,  the  same  reagents  being 
employed,  with  similar  precautions. 

Presuming  that  a  satisfactory  specimen  has  been  pro- 
cured, in  which  exist  cellular  elements,  other  than  those  of 
the  blood  (red  and  white  corpuscles)  or  of  the  organ  in 
which  the  growth  was  seated  (hepatic  cells  in  tumors  of 
the^liver,  renal  epithelium  in  those  of  the  kidney,  for  ex- 
ample), I  will  now  endeavor  to  make  some  suggestions  in 
regard  to  their  import,  premising  that  these  generaliza- 
tions are  subject  to  many  exceptions  in  particular  cases, 
and  that  I  only  offer  them  provisionally,  and  until  those 
who  find  fault  with  them  shall  furnish  some  more  accurate 
and  comprehensive  scheme  of  investigating  pathological 
formations.  Further,  it  must  be  remembered,  as  will  be 
more  fully  explained  near  the  close  of  this  chapter,  that,  in 
the  words  of  Virchow,  our  final  decision  in  regard  to  the 
malignant  or  benignant  nature  of  tumors  "  depends  upon 
the  answer  to  the  question  whether  they  arise  at  a  spot 
to  which  they  belong,  or  not,  and  whether  they  produce  a 
fluid  which,  when  brought  in  contact  with  the  neighboring 
parts,  may  there  exercise  an  unfavorable,  contagious,  or 
irritative  influence,"  so  that,  for  example,  a  growth  com- 
posed of  epithelial-like  cells,  which  is  homologous,  and 
therefore  (theoretically,  at  least)  benignant,  in  the  skin 
where  it  may  appear  as  a  condyloma,  is,  when  developed 
in  any  other  tissue  (as  the  connective),  heterologous,  and, 
consequently,  more  or  less  malignant  in  its  nature. 

If  the  cellular  elements  of  the  specimen  undergoing  ex- 
amination (either  those  present  in  the  juice,  floating  in  the 


EXAMINATION  OF  MORBID   GROWTHS.         311 

fluid  around  the  edges  of  the  thin  section,  or  in  the  sub- 
stance of  the  latter)  present  after  the  action  of  acetic  acid 
and  of  aniline — 

A.  No  well-defined  nuclei,  and  if  they  are  of  a  rounded 
and  oval  form,  about  -guVo"  °^  an  ^nc^  ^n  their  long  diam- 
eter, they  are  probably  what  have  for  many  years  been 
recognized  as  Tubercle  corpuscles  (see  p.  128),  although  the 
experiments  and  observations  of  Yillemin,  Burdon  San- 
derson, Bastian,  Niemeyer,  and  others  have  so  unsettled 
the  views  taught  by  Lebert,  and  for  a  long  time  so  widely 
accepted,  that  it  is  now  extremely  difficult  to  define  what 
constitutes  a  tubercular  deposit,  since  recent  writers  seem 
inclining  to  the  by  no  means  novel  opinion  that  its  cells 
may  be  white   blood  corpuscles  which   have  undergone 
outside  the  blood-vessels  some  abnormal  or  perhaps  incom- 
plete development.     The  student  may  best  familiarize  him- 
self with   "  tubercle  corpuscles"  by  examining  a  nodule 
from  the  lung  of  a  patient  dead  of  pulmonary  tubercu- 
losis. 

If  the  cells  when  treated  as  above  exhibit — 

B.  Well-defined  nuclei,  their  size  and  shape,  as  well  as 
those  of  the  cells  in  which  they  occur,  must  be  carefully 
observed.     Should  the  nuclei  be  very  large,  both  actually 
(roW  °f  an  *nck  across),  and  relatively  to  the  magnitude 
of  their  cells  (twice  or  three  times  the  diameter  of  the 
nucleus  found  in  a  cell  of  epithelium  from  the  mouth  of 
similar  size — see  page  47),  and  many  of  the  cells  present  an 
oval,  caudate,  or  angular  outline,  and  measure  from  ygVg- 
to  -gfa  of  an  inch  in  diameter,  the  growth,  ifheterologous, 
is  probably  cancerous. 

a.  Should  the  cells  be  rounded  or  oval,  ranging  from 
TsVff  to  TOT  °f  an  incn  acr(>ss  (Collis,  Diagnosis  and  Treat- 
ment of  Cancer  and  the  Tumors  analogous  to  it,  London, 
1864,  p.  15  etseq  ),  with  one,  two,  or  three  large  oval  nuclei, 
generally  placed  eccentrically  (see  Fig.  29),  the  cell-wall 


312 


MEDICAL  MICROSCOPY. 


pale,  often  obscured  by  oil  globules,  which  seem  to  adhere 
to  its  inside,  easily  broken  up  by  the  usual  chemical  re- 


FIG.  29. 


SIMPLE  AND  COMPOUND  CANCER  CELLS,  from  well-marked  Encephaloid  disease  of 
the  Duodenum.  Several  corpuscles  "contain  fluid  from  endosmose  which  strongly 
refracts  light."  (After  Bennett.)  X  250  Diameters. 

agents  (weak  acetic  acid,  ether,  iodine,  potash,  etc.),  the 
nucleus  dark  and  well  denned,  with  a  distinct  shining 
nucleolus,  the  former  very  often  obscured  by  the  oil 
globules  in  the  interior  of  the  cell,  but  coming  into  view 
when  the  cell- wall  is  broken  up  and  the  oil  globules  are 
dispersed,  provided  the  reagent  used  be  sufficiently  weak 
(otherwise  it  may  also  be  broken  up),  we  may,  if  the  history 
and  general  symptoms  accord  with  such  an  opinion,  diag- 
nosticate Encephaloid  disease.  (See  page  320  et  seq.  for 
directions  in  doubtful  cases.) 

b.  If  the  cells  are  polygonal,  caudate,  and  angular, 
measure  from  -J^^F  ^°  4oir  °f  an  ^nc^  across,  and  in  the 
sections  are  frequently  seen  to  exist  as  minute  nodules  of 
from  five  to  fifty  cells  aggregated  together  in  oval  or  rounded 
masses  and  imbedded  in  a  more  or  less  dense  and  abundant 


EXAMINATION  OF  MORBID   GROWTH*.         313 

stroma  of  fibrous  tissue,  we  may,  provided  the  other  facts 
of  the  case  consent,  announce  the  presence  of  Scirrkua.* 
(See  Fig.  30.) 

FIG.  30. 


Section  showing  the  arrangement  of  CELLS  and  STROMA  in  SCIRRHOUS  CANCER  of 
the  Mamma.    (After  Bennett.)     X  250  Diameters. 

Mr.  Collis  (op.  cit.)  divides  this  variety  of  cancer  into 
two  forms,  the  Atrophic  and  the  Lardaceous ;  the  former 
term  being  applied  to  such  kinds  of  malignant  disease  as 
reduce  the  size  of  an  organ  below  its  natural  dimensions, 
as  is  often  seen  when  it  attacks  the  female  mamma?.  The 
more  common  form,  lardaceous  scirrhus,  is  characterized 
by  presenting  along  with  the  cancer-cells  a  large  deposit 
of  fat ;  since  it  is  essentially  an  infiltrating  growth,  we  are 
often  unable  to  recognize  it  as  a  distinct  tumor,  and  in 

*  According  to  some  authorities,  there  are  not  unfrequently 
examples  of  Acute  Scirrhus,  which  so  closely  resemble  Firm  En- 
cephaloid  tumors,  that  the  microscope  may  fail  to  demonstrate 
any  morphological  difference  between  them. 

27* 


314  MEDICAL  MWROS COPT. 

the  breast  it  is  indicated  by  "an  increase  in  the  size  of  the 
organ  ;  a  brawny  feel  and  look  in  the  skin,  produced  by  its 
early  infiltration  with  cancer-cells  ;  early  poisoning  of  the 
glands  ;  and,  in  general,  rather  rapid  progress." 

c.  If  the  growth  is  chiefly  made  up  of  a  jelly-like  mat- 
ter (contained  in  little  cysts  or  loculi  varying  from  the 
size  of  a  pin's  head  to  that  of  a  pea),  and  under  the  micro- 
scope seen  to  be  composed  of  rounded  or  oval  cells,  small 
in  size,  with  small  nuclei  associated  with  delicate  fiber,  it 
is  a  Colloid  tumor,  which,  although  generally  classed  as  a 
form   of  cancer    by  the  older  writers,  is  not  at  present 
universally  so  considered. 

d.  Should  the  cells  be  large,  more  or  less  regularly  oval 
or  flask-shaped,  with  numerous  oval  nuclei,  not  so  large  as 
the  nuclei  of  cancer,  and  departing  but  little  from  the  rela- 
tive magnitude  of  ordinary  epithelium,  inclosed  in  pale 
cell-walls  so  fragile  that  they  readily  break  up,  and  allow 
many  free  nuclei  to  be  seen  in  each  specimen,  we  may 
provisionally  diagnosticate  the  Myeloid  tumor  of  Paget 
and  Collis  (Fibroplastic  of  Lebert),  as  Epulis,  etc.     These 
growths,  arranged  by  Collis  among  the  Cancroids,  are  a 
large  class,  including  many  tumors  that  are  highly  malig- 
nant in  their  later  stages,  though  often  perfectly  amenable 
to  treatment  at  first.    They  specially  affect  the  gums  and 
Schneiderian  membrane ;  the  fibrous  periosteum  is  also  a 
favorite  seat.    As  a  rule,  they  are  much  more  local  in  their 
action  than  cancers,  "  although  it  is  certainly  impossible," 
says  Collis,  "to  draw  an  accurate  line  between  the  two, 
many  tumors  occupying  as  they  do  the  boundary  of  each 
form."     According  to  Virchow,  however  (Review  of  his 
"  Krankhaften  Geschwiilste,"  American  Journal  of  Medi- 
cal Sciences,  June,  1865),  the  criterion  for  distinguishing 
the  medullary  sarcoma  presenting  round  cells,  from  car- 
cinoma, lies  in  the  relation  of  the  intercellular  substance. 
The  structure  of  the  sarcoma  is  never  alveolar,  like  that 


EXAMINATION  OF  MORBID   GROWTHS.         315 

of  cancer,  where  the  cells  lie  heaped  together  in  meshes  ; 
on  the  contrary,  each  cell  is  separated  from  its  neighbors 
by  the  intercellular  substance.  The  latter  may  be  reduced 
to  a  minimum,  but  the  tissue  is  still  homogeneous  and 
not  meshy.  The  danger  of  confounding  sarcoma  with 
cancer  is  especially  great  in  that  form  called  Sarcoma 
Giganto-cellulare,  where  the  cells  are  multi-nucleated,  and 
sometimes  so  large  that  they  can  be  detected  with  the 
naked  eye.* 

*  Paget  (Lectures  on  Surgical  Pathology,  3d  edition,  London, 
1870,  p.  544)  remarks,  "  The  term  Sarcoma  has  recently  been  re- 
vived by  Virchow  and  other  pathologists  in  Germany,  and  em- 
ployed to  designate  a  group  of  tumors  '  the  tissues  forming  which 
belong  to  the  series  of  connective  substances,  but  which  are  distin- 
guished from  the  tumors  formed  of  the  connective  tissues  by  the 
preponderating  development  of  the  cell-elements.'  The  tissue  of 
granulations  formed  during  the  inflammatory  irritation  of  the 
connective  tissue  is  regarded  as  the  normal  prototype  of  these 
tumors." 

The  varieties  of  Sarcoma  include — 

"a.  Tumors  with  spindle-shaped  cells,  the  fibroplastic  cells  of  Lebert 
(Spindel-zellen  sarcoma,  Recurrent  fibroid  tumors,  Fibroplastic  tumors). 

"  6.  Tumors  with  colossal,  many  nucleated,  myeloid  cells  (Riesen- 
zellen  sarcoma,  Myeloid  tumors). 

"c.  Tumors  with  small  round  cells  like  the  lymph  or  white  blood  cor- 
puscles, or  pus,  or  granulation  cells  (Rund-zellen  sarcoma,  Granulations 
sarcoma,  Glio-  or  Lympho-sarcoma). 

"d.  Tumors  with  stellate  cells,  and  a  gelatinous,  shiny,  intercellular 
substance,  not  unlike  the  material  found  in  a  myxoma  (Myxo-sarcoma). 

"  e.  Tumors  with  round  or  variously-shaped  cells,  most  of  which  are  of 
large  size,  and  are  usually  imbedded  in  a  fibrous  matrix.  In  structure 
no  well-defined  character  distinguishes  these  tumors  from  Carcinoma. 

"/.  Tumors  in  which  the  cells  contain  a  considerable  proportion  of 
pigment,  which  is  most  frequently  found  in  the  cells  described  in  the 
last  group,  in  the  tumors  with  round  and  with  fusiform  cells  (Pigment 
sarcoma,  Melanoma). 

"In  all  these  forms  an  intercellular  substance  occurs,  which  may  bo 
either  homogeneous  or  fibrous,  or  which  may  present  a  delicate  netlike 
or  trabecular  structure,  such  as  is  found  in  a  lymphatic  gland." 

Mr.  Paget,  however,  "is  inclined  to  think  that  the  group  is  too 


316  MEDICAL  MICROSCOPY. 

e.  If  the  cells  composing  the  growth  under  examination 
are  usually  small,  elongated,  caudate,  and  oat-shaped,  with 
small  nuclei,  and  are  associated  with  many  free  nuclei  and 
young  cells,  all  arranged  in  an  irregularly  fibrous  manner, 
we  probably  have  to  deal  with  the  Recurrent  fibroid  of 
Paget  (Sarcoma  fibro-cellulare  of  Yirchow,  Fibro-nucleated 
of  Bennet).  These  tumors  are  firm,  fleshy,  and  dry ;  tear 
with  an  imperfectly  fibrous  grain  ;  when  scraped,  yield  no 
milky  juice,  and  are  found  to  be  tough  when  we  attempt 
to  break  them  up  for  minute  inspection ;  in  outline  they 
are  either  globular,  where  they  can  grow  freely,  or,  if  re- 
strained in  one  direction  by  fascia  or  bone,  they  take  an 
oval  or  elongated  form,  but  still  preserving  the  globular 
tendency,  even  if  grooved  by  a  band  of  fascia  or  tendon. 

Again,  Yirchow,  "On  Tumors,  vol.  ii.  p.  177''  (quoted 
by  Prof.  Tyson  in  his  excellent  paper  on  a  case  of  Spindle- 
celled  Sarcoma,  Pennsylvania  Hospital  Reports,  1869, 
p.  243),  observes,  in  speaking  of  Sarcomata  generally, 
"  Under  all  circumstances  there  remains  the  common 
type, — namely,  a  tissue  in  which  cells  and  intercellular 
substance,  even  though  the  latter  be  reduced  to  a  minimum, 
are  united  into  a  relatively  firm  and  coherent  structure,  a 
structure  which  contains  blood-vessels,  and  is  in  continu- 
ous connection  with  the  adjacent  connective  tissue.  In 
this,  sarcoma  is  essentially  distinguished  from  all  epithe- 
lial formations  and  all  cancers  and  cystic  tumors,  in  which 
the  essential  part  places  itself  adjacent  to  previously  exist- 
ing structures  as  something  different,  in  which  the  specific 
elements  of  the  tumor  are  laid  down,  not  continuously, 
but  more  or  less  discontinuously,  in  simple  contiguity.'11 

vague,  and  is  made  to  embrace  tumors  which  are  too  diverse,  both 
in  consistence,  color,  vascularity,  structure,  mode  of  growth,  seat, 
course,  and  effects  on  the  patient,  to  be  included  under  one  com- 
mon term." 


EXAMINATION  OF  MORBID    GROWTHS. 


317 


/.  Should  the  cellular  elements  nearly  resemble  the 
normal  ones  of  the  part,  differing  but  little  in  their  size, 
shape,  position,  and  appearance  of  their  nuclei,  etc.,  the 
tumor,  if  it  originates  from  an  epithelial  surface,  may  be 
designated  as  an  Epithelioma,  Dr.  Beale,  who  remarks 
that  the  so-called  Epithelial  growths  resemble  Cancerous 
tumors  more  closely  than  other  structures,  tabulates  their 
chief  differences  thus  : — 


"  CANCEROUS. 


with 


the 
or 


"  Cells  not  connected 
matrix  in  a  regular  E 
forming  lamime. 

"  Cells  differing  much  from  each 
other  in  size  and  form. 

"Cells  readily  separable  from 
each  other. 

"  Cells  not  connected  together  at 
their  margins;  their  edges  seldom 
forming  straight  lines. 

"  Cells  containing  several  smaller 
cells  in  their  interior,  often  met 
with. 

"  Nuclei,  varying  much  in  size 
and  number,  in  different  cells. 

"Juice  scraped  from  the  cut  sur- 
face containing  many  cells  floating 
freely  in  the  fluid  and  not  connected 
with  each  other." 


"  EPITHELIAL  GROWTHS. 

"  Cells  connected  with  the  matrix 
often  forming  distinct  lamina). 

"  Cells  resembling  each  other  in 
size  and  general  outline. 


"  Cells  often  cohering  by  their 
edges,  which  generally  form  straight 
lines;  three  or  four  cells  being  fre- 
quently found  united  together. 

"  Cells  usually  containing  one 
nucleus. 

"  Nuclei  not  varying  much  in 
size  in  different  cells. 

"  Juice  scraped  from  the  cut  sur- 
face containing  small  collections  of 
cells  which  are  often  connected  with 
each  other." 


According  to  Paget  (op.  tit.),  in  Epithelial  cancers  the 
natural  structures  of  the  papillae  are  replaced  by  cancer 
structures,  the  cell,  like  epithelium,  lying  not  only  upon 
the  papillae  but  within  them;  thus  constituting  an  essen- 
tial distinction  between  such  a  cancerous  growth  and  a 
simple  warty  or  papillary  one. 

g.  If  the  histological  elements  of  the  tumor  as  seen  in  a 
thin  section  have  so  far  undergone  an  almost  normal  develop- 
ment into  ordinary  fibrous  tissue  that  very  few  rounded  cells 


318  MEDICAL   MICROSCOPY. 

or  nuclei  can  be  discovered,  and  the  growth  is  supplied  with 
blood-vessels  only  to  the  extent  necessary  for  its  nutrition, 
it  probably  belongs  to  the  Fibrous  tumors  (Fibromata). 
This  form  of  morbid  growth  as  typically  developed  in  the 
uterus  is  generally  round,  imbedded  in  the  substance  of 
-the  organ,  and  bulging  out,  when  of  large  size,  equally  on 
its  peritoneal  and  mucous  surfaces.  It  is  also  frequent  as 
polypus  of  the  nose  and  pharynx,  fibrous  tumor  of  the 
prostate  gland,  of  the  lobes  of  the  ear,  alae  of  the  nose,  scro- 
tum, etc. 

h.  If  the  fibrous  tissue  is  supplied  with  a  superabundance 
of  blood-vessels  which  have  become  largely  dilated,  we 
have,  according  to  Collis,  when,  these  enlarged  vascular 
canals  continue  permeable,  the  Erectile,  and  when  they 
become  obstructed,  the  Fibrocystic,  tumor.  Should  they 
attack  bone  or  cartilage,  they  often  become  in  time  them- 
selves the  seat  of  osseous  or  cartilaginous  growth,  probably 
constituting  one  form  of  the  Osteosarcomata  and  Chondro- 
sarcomata  of  Yirchow  ;  and  should  the  abnormal  formation 
occur  in  the  substance  of  a  nerve  and  be  associated  with 
an  excessive  development  of  nerve-cells  and  fibers,  it  is 
known  by  the  name  of  Neuroma. 

C.  If  on  examination  with  the  naked  eye  or  under  the 
microscope  the  cellular  elements  of  the  morbid  growth  are 
found  to  be  of  very  minor  importance,  it  may  probably  be 
classed  among  the  following. 

a.  Should  the  tumor  be  made  up  of  one  or  more  cysts 
(filled  with  serum  variously  colored)  whose  walls  show, 
where  examined  microscopically,  no  tendency  in  any  part 
towards  a  more  unhealthy  growth,  it  is  a  simple  Cystic  one, 
such  as  are  common  in  the  ovaries  and  in  the  female  mammaB. 

b.  If  a  disposition  to  the  formation  of  small  cysts,  or  to 
the  production  of  a  solid  growth,  is  apparent  in  the  parietes 
of  the  tumor,  it  may  be  denominated  a  Proliferous  cyst. 
(This  more  or  less  adventitious  formation  may,  and  often 


EXAMINATION   OF   MORBID   GROWTHS.         319 

does,  become  cancerous,  fibrous,  etc.,  in  which  case  of  course 
an  effort  should  be  made  to  classify  it  according  to  the 
characters  of  its  cellular  elements  as  above  described.)  The 
Adenoid  tumor  of  the  breast,  so  fully  described  by  Mr. 
Fagot  (Adenoma,  see  op.  cit.,  p.  558  et  seq.),  appears  to  be 
composed  of  a  sero-cystic  tumor,  into  which  the  growth  of 
a  tissue  closely  resembling  if  not  identical  with  hyper- 
trophied  gland-structure  has  occurred. 

c.  Should  the  contents  of  the  cyst  be  sebaceous  matter, 
with  a  few  epithelial  cells  imbedded  therein,  and  perhaps 
crystals  of  Cholestearine,  it  may  be  styled  a  Sebaceous  tu- 
mor.  Such  formations  are  generally  small,  and  result  from 
the  obstruction  and  consequent  irritation  of  a  sebaceous 
gland. 

d.  If  the  substance  of  the  growth  is  composed  of  the 
ordinary  large,  oval,  fat  vesicles  of  adipose  tissue,  it  may 
be   classified  as   a  Fatty  tumor,   or   Lipoma.     The   term 
Steatoma,  according  to  Beale,  is  applied   both  to   Fatty 
tumors   which    contain    a   quantity   of  fibrous   tissue   in 
addition  to  the  fat  vesicles,  and  to  "  encysted  tumors  origi- 
nating in  sebaceous  follicles,  and  containing  a  soft,  pulpy 
material,  rich  in  fatty  matter  but  not  containing  fat  vesi- 
cles.    The  fat  is  in  the  fornrof  small  globules,  or  merely 
granular." 

If  the  cellular  elements  of  any  of  the  morbid  formations 
above  mentioned  become  the  seats  of  pigmentary  deposit 
to  such  an  extent  that  they  cause  the  whole  mass  to  pre- 
sent a  brownish,  purplish,  or  blackish  color,  the  patho- 
logical condition  is  called  Melanosis.  Thus,  we  may  have 
occurring  simple  fibrinous  melanosis,  where  the  microscope 
shows  only  the  ordinary  lymph  cells  of  inflammation,  filled 
with  pigment  granules ;  'rnelanotic  cancer  (generally  of 
the  eyeball),  where  in  like  manner  the  cancer  cells  are 
stuffed  with  brown  or  black  particles ;  and  less  frequently 
other  forms  of  the  disease. 


320  MEDICAL  MICROSCOPY. 

By  carefully  following  the  foregoing  scheme,  students 
will,  I  trust,  be  enabled  to  classify  a  majority  of  the  morbid 
growths  which  come  under  their  notice ;  but  among  the 
remainder  some  will  be  found  which  the  contradictory 
results  of  naked-eye  inspection  and  microscopical  research, 
local  and  general  signs  or  symptoms,  and  history  of  the 
case,  will  render  extremely  difficult  to  place.  This  appar- 
ent conflict  of  our  data  (always,  of  course,  explicable  if  we 
had  but  the  knowledge  and  the  capacity  which  would 
enable  us  to  discover  all  the  disturbing  influences,  whether 
subjective  or  objective,  that  produce  it)  may  sometimes  be 
dissipated  by  a  second  or  even  a  third  investigation  of  the 
entire  evidence  we  can  obtain ;  but  if  not,  we  must  make 
an  effort  to  estimate  the  comparative  value  of  opposing 
testimony,  and  so  arrive  at  a  probable  if  not  a  positive 
diagnosis.  Since  the  most  important  question  to  be 
determined  is  generally  whether  a  particular  tumor  is 
malignant  or  not,  the  following  suggestions  may  be  of 
service  as  aids  towards  an  accurate  valuation  of  micro- 
scopical evidence  in  that  respect. 

When  we  can  be  sure  that  no  epithelial  cells  from  a 
normal  cutaneous,  mucous,  or  glandular  structure  have 
become  mingled  with  the  sample  of  morbid  growth  under 
examination,  detection  of  large  angular  and  polygonal 
cells  floating  abundantly  in  the  juice  scraped  from  a  cut 
surface  is  strongly  indicative  of  cancer ;  but  any  one  who 
will  puncture  his  finger  and  then  scrape  off  the  drop  of 
blood  that  exudes,  with  a  sharp  scalpel  will  be  convinced, 
by  the  thousands  of  epithelial  cells  he  can  find  among  the 
red  disks  (even  when  only  a  moderate  force  has  been 
applied),  how  necessary  is  the  most  scrupulous  care  to 
avoid  contamination.  In  a  recent  case  in  the  lower  sur- 
gical ward  of  the  Pennsylvania  Hospital,  where  I  was 
requested  to  examine  the  discharge  from  a  tumor,  supposed 
to  be  malignant,  seated  beneath  the  chin  of  a  patient,  I 


EXAMINATION  OF  MORBID    GROWTHS.         321 

took  the  precaution  of  first  pressing  out  some  of  the  dis- 
charge, to  wash  away  any  foreign  matters  from  the  lips  of 
the  fistulous  opening,  and  then  to  remove  a  portion  of  the 
fluid,  by  means  of  a  syringe,  from  within  the  sinus,  for 
investigation ;  and  yet  I  was  surprised  to  find  on  the 
second  slide  which  I  inspected,  a  fine  specimen  of  Pediculus 
capitis,  which  must  have  come  from  the  surface  of  the 
man's  body,  and  probably  was  taken  up  from  the  margin 
of  the  opening,  in  spite  of  all  my  care.* 

Great  irregularity  in  the  size  and  shape  of  cells  which 
we  can  be  certain  have  been  developed  in  close  juxta- 
position with  each  other,  is  an  important  criterion  of 
malignant  growth,  and  by  its  degree  will  often  give 
ground  for  a  surmise  as  to  the  virulence  of  the  malignant 
tendency.  Although,  as  any  one  may  satisfy  himself  by 
inspecting  different  layers  of  epithelial  cells  from  the  skin 
or  a  mucous  membrane,  those  from  the  deeper  strata  have 
not  only  a  different  shape  but  vary  in  regard  to  the  size 
of  their  nuclei,  and,  as  remarked  by  Prof.  Beale,  cells 
may  almost  always  be  obtained  from  the  urinary  bladder 
which  present  all  the  sensible  peculiarities  so  long  con- 
sidered characteristic  of  cancer  cells  (see  Fig.  7,  p.  98), 
yet  it  will,  I  think,  almost  always  be  found  that  elements 
of  the  same  normal  tissue,  in  the  same  stage  of  develop- 
ment, and  therefore  in  close  juxtaposition,  present  the  same 
general  appearance.  Thus,  for  example,  a  middle-aged 


*  In  this  case,  numerous  polygonal  and  caudate  cells,  somewhat 
resembling  cancer  cells,  although  probably  derived  from  the  sur- 
face of  the  skin,  were  present;  but  in  addition  I  found  several 
fragments  of  tissue  resembling  that  delineated  in  Fig.  30.  Upon 
these  a  probable  diagnosis  of  malignant  disease  was  made,  amplv 
justified,  as  far  as  could  be  in  that  time,  by  the  rapid  progress  of 
the  affection  during  the  succeeding  month,  at  the  end  of  which 
period  the  patient,  unfortunately,  left  the  Hospital,  and  was  lost 
sight  of. 

28 


322  MEDICAL  MICROSCOPY. 

patient,  admitted  into  the  men's  medical  ward  of  the  Penn- 
sylvania Hospital  during  the  summer  of  1869,  with  Bright's 
disease,  presented  on  his  entrance  into  the  institution  a  ma- 
lignant-looking sore  in  the  palm  of  his  right  hand,  from 
which,  at  the  request  of  the  attending  physician,  I  obtained 
a  little  slice  of  tissue  for  the  purpose  of  microscopical  inves- 
tigation. Notwithstanding  the  cancerous  aspect  of  the 
ulcer,  I  found,  on  placing  a  fragment  of  the  section  I  had 
procured,  moistened  with  liquor  potassse,  under  a  power 
of  1200  diameters,  that  the  cellular  elements  were  of 
nearly  equal  size,  possessed  nuclei  of  about  the  same  mag- 
nitude, and  were  arranged  quite  symmetrically  in  layers 
superimposed  upon  each  other.  Chiefly  on  this  evidence  I 
gave  the  opinion  that  the  growth  was  simply  an  irritated 
condyloma.,  and  had  the  satisfaction  of  seeing  it  entirely 
disappear  in  the  course  of  a  few  weeks,  under  appropriate 
treatment. 

Mr.  Paget  states  (p.  616,  op.  cit.)  that  he  knows  of  no 
innocent  tumors,  except  the  cartilaginous,  in  which  this 
multiformity  of  cell  contour  is  imitated. 

The  occurrence  of  fatty  degeneration,  as  shown  under  a 
high  objective  by  the  appearance  of  minute  globular  par- 
ticles of  oil,  similar  to  those  drawn  in  Renal  Epithelium 
in  Fig.  6,  is  likewise  an  important  assistance  in  the  diag- 
nosis of  cancerous  growth,  since,  although  epithelial  cells 
from  the  mucous  membranes  and  the  cutaneous  surface,  as 
they  advance  in  age  exhibit  a  granular  appearance,  which 
under  a  moderate  power  presents  a  similar  aspect,  when 
sufficiently  magnified  this  condition  may  be  often  seen  to 
originate  in  the  very  minute  cylindrical  spores  of  low 
forms  of  vegetable  life  (Bacterida)  developed  in  their  sub- 
stance as  their  own  vitality  wanes.  Of  course,  when  we 
are  able  to  satisfy  ourselves  that  the  cellular  elements 
under  examination  have  not  been  contaminated  by  any 
mixture  with  normal  epithelial  cells,  recognition  of  this 


AMM  MIXATION  OF  MORBID    GROWTHS.         32.'* 

gran ul :u-  appearance,  \vith  even  a  low  objective,  is  a  valu- 
able criterion;  and,  indeed,  in  well-marked  cases  of  malig- 
nant tumor,  especially  when  rapidly  growing,  the  amount 
of  fatty  degeneration  is  so  great  that  the  granular  appear- 
ance far  exceeds  any  produced  by  the  development  of 
fungi,  approximating  very  closely  to  that  presented  by 
renal  epithelium  in  severe  cases  of  advanced  Bright's 
disease.  (See  Fig.  5, /and  g.) 

Another  important  indication  of  malignant  disease  is  the 
discovery  of  cells  containing  two,  three,  or  more  nuclei, 
and  of  others,  the  so-called  mother-cells,  which  arc  com- 
posed of  from  two  to  ten  small  cells,  inclosed  within  one 
common  envelope.  Both  of  these  characteristics  are  so 
rare  in  the  superficial  layers  of  epithelium  in  its  normal 
condition  that  in  many  cases  where  they  occur  abundantly 
in  the  juice  of  a  suspicious  tumor  they  may  be  considered 
almost  pathognomonic  of  carcinoma. 

In  numerous  instances  I  have  noticed  that  the  nuclei  of 
cells  from  undoubted  cases  of  cancer,  when  very  highly 
magnified,  were  much  more  irregular  in  their  outline  than 
those  of  epithelial  cells  ever  appear  to  be  ;  they  also  showed 
a  tendency  to  coalesce  (when  more  than  one  existed)  at 
their  edges.  Instead  of  the  slightly  eccentric  position 
usually  occupied  by  the  nucleus  of  an  epithelial  cell,  the 
corresponding  portion  of  a  cancer  cell  frequently  varies  in 
its  situation  relative  to  the  parietes,  sometimes  occupying 
the  exact  center,  at  others  filling  up  one  extremity,  or 
closely  applying  itself  to  the  side  of  the  cell-wall. 

Dr.  Beale  states  that  "  it  is  impossible  to  lay  down  any 
definite  characters  which  shall  in  every  case  serve  to  dis- 
tinguish a  cancerous  tumor  from  other  forms  of  morbid 
growths ;  but  a  tumor  from  the  cut  surface  of  which  a 
milky  juice  is  poured  out,  and  which,  upon  microscopical 
examination,  is  found  to  consist  principally  of  cells,  exhibit- 
ing the  general  characters  above  referred  to,  and  arranged 


324  MEDICAL  MICROSCOPY. 

in  the  meshes  of  a  fibrous  stroma,  may  be  pronounced  to 
be  of  a  cancerous  nature." 

In  regard  to  the  type  of  malignant  formation,  Mr.  Collis 
asserts  that  cancer  secondary  to  either  scirrhous  or  enceph- 
aloid  is  always  of  the  latter  character ;  and  Paget  remarks 
that  of  100  primary  hard  cancers  he  believes  that  not  less 
than  95  will  be  found  in  the  breast. 

The  microscopist  will  sometimes  be  called  upon,  after 
examining  a  tumor  removed  during  the  lifetime  of  a  patient 
to  express  an  opinion  as  to  whether  the  disease  is  or  is  not 
likely  to  recur,  and  in  the  former  instance  as  to  what  period 
will  elapse  before  such  return  of  the  complaint  may  be 
expected.    In  arriving  at  any  conclusion  in  regard  to  these 
points,  he  must  remember  that  not  alone  by  the  characters 
of  the  cellular  elements  composing  the  growth,  but  by  all 
the  circumstances  of  the  case  taken  in  conjunction  with 
these,  can  he  arrive  at  a  conclusion  which  will  be  even 
approximatively  accurate.    Thus,  as  remarked  by  Yirchow 
(Cellular  Pathology,  p.  530):  "  Cancer,  cancroid,  or  epi- 
thelioma,  pearly  tumors  or  cholesteatoma,  nay,  perhaps 
the  dermoid  growths  which  produce  hairs,  teeth,  and  seba- 
ceous glands,  and  so  frequently  occur  in  the  ovary,  all 
these  are  formations  in  which  there  is  a  pathological  pro- 
duction of  epithelial  cells  ;  but  they  constitute  a  graduated 
series  of  different  kinds,  which  extends  from  those  which 
are  entirely  local,  and,  in  the  usual  meaning  of  the  word, 
perfectly  benignant,  to  the  extremest  malignity.    The  mere 
form  of  the  cells  which  compose  a  structure  is  of  no  de- 
cisive value.     Cancer  is  not  malignant  because  it  contains 
heterologous  cells,  nor  cancroid  benignant  because  its  cells 
are  homologous ;  they  are  both  malignant,  and  their  ma- 
lignity only  differs  in  degree.    The  forms  which  yield  dry, 
juiceless  masses   are  relatively  benignant;   those  which 
produce  succulent   tissues  have   always  more  or  less  a 
malignant  character.     *     *     *     Cancroid  remains  for  a 


EXAMINATION  OF  MORBID   GROWTHS.         325 

very  long  time  local,  so  that  the  nearest  lymphatic  glands 
often  do  not  become  affected  until  after  the  lapse  of  years, 
and  then  again  the  process  is  for  a  long  time  confined  to 
the  disease  of  the  lymphatic  glands,  so  that  a  general 
outbreak  of  the  disease  in  all  parts  of  the  body  does  not 
take  place  until  late,  and  only  in  rare  instances.  In  cancer 
proper  the  local  progress  is  often  very  rapid,  and  the  dis- 
ease early  becomes  general ;  a  cure  even  for  a  short  period 
is  so  rare  that  in  France  the  complete  incurability  of  cancer, 
properly  so  called,  has  been  asserted  and  maintained  with 
success." 

The  PROGNOSIS  in  well-marked  Encephaloid  disease  is, 
as  is  well  known,  extremely  unfavorable, — recovery,  with 
or  without  operation,  being  rare.  In  Scirrhus,  the  pros- 
pect of  cure  is  a  little  less  hopeless  and  the  probable  dura- 
tion of  life  decidedly  greater,  being  in  a  typical  case, 
according  to  Paget's  statistics  (op.  cit.,  pp.  649,  695),  four 
years,  while  a  like  example  of  Encephaloid  would  probably 
arrive  at  a  fatal  termination  within  about  half  that  time. 

Of  Myeloid  or  Fibro-plastic  tumors,  Mr.  Collis  declares 
that  they  are  often  perfectly  amenable  to  treatment  at  first, 
and  narrates  some  cases  in  which  operation  proved  com- 
pletely successful,  although  in  the  majority  of  instances  a 
return  of  the  malady  in  the  cicatrix  must  be  anticipated. 

According  to  the  same  author,  Recurrent  Fibroid 
(Paget)  "  is  far  less  malignant  than  cancer,  prone  to  recur, 
yet  not  incapable  of  ultimate  cure,"  by  repeated  operation. 
"It  is  about  equally  removed  from  cancers  on  the  one 
hand  and  simple  fibrous  tumors  on  the  other." 

Fibrous  tumors,  including  the  Erectile,  Cystic,  and 
Neuromatous  tumors,  do  not,  with  rare  exceptions,  poison 
the  glands  or  system,  and  "  when  removed  completely 
they  do  not  seem  to  return  ;  but  it  must  be  manifest  that 
some  of  them  are  so  circumstanced  as  to  be  incapable  of 


326  MEDICAL   MICROSCOPY. 

complete  removal ;"  and  the  same  remarks  apply  as  a  gen- 
eral rule  to  Fatty-  tumors  with  equal  force. 

The  progress  of  Epithelioma  after  removal  by  any 
operation  varies  so  much  with  the  seat  of  the  disease,  and 
indeed  in  any  case  is  so  extremely  uncertain,  that  I  fear  no 
satisfactory  rules  can  be  given  in  regard  to  it  in  the  present 
state  of  our  knowledge,  except  the  general  one  laid  down 
by  Yirchow  and  quoted  above.  In  a  majority  of  cases, 
after  operation,  sooner  or  later  it  recurs,  either  in  the  cica- 
trix  or  the  neighboring  glands;  but  in  a  considerable 
number  of  instances,  forming  a  much  larger  percentage 
than  is  the  case  with  cancer,  a  permanent  cure  appears  to 
be  effected. 


.A.. 
LIST  OF  MICROSCOPE   MAKERS    AND  DEALERS. 

Boston  Optical  Works,  C.  H.  Stoddar,  Treasurer;  R.  B. 
Tolles,  Superintendent;  No.  66  Milk  St.,  Boston,  Mass. 
Grunow,  J.  and  W.,  No.  52  E.  30th  St.,  New  York. 
Ilartnack  and  Oberhiiuser,  Place  Dauphine  21,  Paris. 
McAllister,  T.  N.,  No.  49  Nassau  St.,  New  York. 
McAllister,  W.  Y.,  No.  728  Chestnut  St.,  Phila.,  Pa, 
Nachet,  Rue  St.  Severin  It,  Paris,  France. 
Powell  &  Lealand,  No.  170  Euston  Road,  London,  Eng. 
Queen,  J.  W.,  &  Co.,  No.  924  Chestnut  St.,  Phila.,  Pa. 
Ross,  No.  53  Wigmore  St.,  London,  W.,  England. 
Smith,  Beck  &  Beck,  31  Cornhill,  London,  England. 
Tolles,  R,  B.     See  Boston  Optical  Works. 
Wales,  William,  Fort  Lee,  New  Jersey. 
Zentmayer,  Joseph,  No.  147  S.  Fourth  St.,  Phila.,  Pa. 


IB. 
LIST  OF   WORKS  ON   THE   MICROSCOPE,  ETC. 

TO    THE    AUTHORS   OF   MOST    OF   WHICH   THE   WRITER  GRATEFULLY 
ACKXOAVLEDGES    HIS    INDEBTEDNESS. 

Anderson,  D.  M'Call,  Parasitic  Affections  of  the  Skin, 
London,  1868. 

Be'alc,  Prof.  L.  S.,  Microscope  in    Practical    Medicine, 
3d  Edition  (Phila.),  1807- 

(  327  ) 


328  APPENDIX. 

Beale,  Prof.  L.  S.,  How  to  Work  with  the  Microscope, 
4th  Edition,  London,  1868. 

Beale,  Prof.  L.  S.,  Kidney  Diseases  and  Urinary  De- 
posits, 3d  Edition,  Phila.,  1869. 

Carpenter  on  the  Microscope,  edited  by  Prof.  F.  G.  Smith, 
Phila.,  1856. 

Davies,  Thomas,  Preparing  and  Mounting  of  Microscopic 
Objects,  London. 

Griffith  &  Henfrey,  Micrographic  Dictionary,  London, 
1860. 

Hassall,  A.  H.,  Illustrations  of  Microscopical  Anatomy, 
New  York,  1869. 

Hogg,  Jabez,  The  Microscope,  London,  1869. 

Kolliker,  Manual  of  Human  Microscopic  Anatomy. 
Translated  by  Dr.  F.  Chance,  J.  B.  Lippincott  &  Co., 
Phila. 

Suffolk,  W.  T.,  Microscopical  Manipulation,  J.  B.  Lip- 
pincott &  Co.,  Phila.,  18*70. 

Tyson,  Prof.  James,  The  Cell  Doctrine,  Phila.,  1870. 

Yon  Diiben,  Treatise  on  Microscopical  Diagnosis.  Trans- 
lated by  Dr.  Louis  Bauer,  New  York,  1859. 

Wormley,  Prof.  T.  G.,  Micro-Chemistry  of  Poisons, 
New  York,  1869. 


I3TDEX. 


Abortion,    Diagnosis    of.    by     Placental 

Tufts,  -J47. 

Ararus  Folliculorum,  258. 
Aiarus  Scabiei,  Cuniculi  of,  255. 
description  of,  255. 
mode  of  detecting,  254. 
Acetic  Acid,  as  a  Microscopic  Reagent,  36. 
Action  on  Pus  Corpuscles  (Leu- 
cocytes), 160. 
Achorion  Schcenleinii.  269. 

characteristics  of,  270. 
mode  of  detecting,  269. 
Adjustment    of    Lenses    for    thin    glass 

cover,  2;">. 
mode  of  using,  64. 
Air-bubbles,  appearances  of,  beneath  the 

Microscope,  53. 

Alopecia  areata.  description  of,  279. 
Amoeba,  characters  of,  177. 
Amoeboid     movement     of     Leucocytes, 

155, 178. 

Amplifier,  description  of  the,  65. 
Anaemia,  state  of  blood  in  case  of,  186. 
Analysis    of    Blood-Stains    by   Spectro- 

Microscope,  297,  298. 
ANDERSON,  DR.  M'CALL,  on  Parasitic  Skin 

Diseases,  267. 
Aniline,  solution  of,  37. 
Aphtha,  cause  of,  166,  168. 
diagnosis  of,  166. 
treatment  of,  167. 
Arsenious  Acid,  detection  of,  304. 
Ascaris  lumbricoidos,  description  of,  240. 
ova  of,  241. 

mode  of  detecting,  242. 
Fecal  matters  resembling,  243. 
Aspergillus,    growth    of,     in     external 
ear,  281. 

Bacteria  in  Urine,  104. 
Bacterida,  characters  of,  104. 
BarreswiPs  Test  for  Sugar,  38. 
Beale,  Prof.  L.  S.,  on   Lung -Tissue    in 
Sputum,  213. 

Pus  Corpuscles,  159. 

Tubercle  Corpuscles,  128. 
Benzoic  Acid  in  Urine,  106. 
Bile,  vomiting  of,  'J25. 
Bilharzia  haematobia,  139, 193. 
Binocular  Microscope,  description  of,  31. 
Blood,  Constituents  of.  174. 


Blood  Corpuscles,  relative  number  of,  179. 
red,  17.".. 

cell-walls  of,  176. 
changes  in  Chloroform  Nar- 
cosis, 195. 
in  Anaemia,  186. 
Cholera,  187,  191. 
Effused,  192. 
Retained    menstrual, 

246. 

table  of  sizes  of,  288. 
white,  176. 

structure  of,  179. 
origin  of,  181. 
Entozoa in, 193. 
examination  of,  181. 
Fibrin  of,  189. 

Halford's  "  Peculiar  Cells"  in,  188. 
in  Urine,  examination  of,  121. 
Pigment  and  other  cells  in,  192. 

imitations  of,  146. 
vegetable  organisms  in,  193. 
Blood-Stains,  changes  of  corpuscles  in,  289. 
characters  of,  294.          • 
crystals  obtained  from,  293. 
curious  criminal  case  involving, 

295. 
delicacy  of  various  methods  for 

detecting,  283. 
discovery  by  spectrum  analysis, 

296. 

Guaiacum,  test  for,  297. 
menstrua  for  examining,  290. 
mode  of  examining,  Author's.284. 
M.  Briand's,  291. 
Dr.  Caspar's,  291. 
preliminaries  to  examining,  282. 
produced  by  diluted  blood,  298. 
Bright's  Disease,  Amyloid  form  of,  79. 

diagnosis  of,  84. 
Cirrhotic    or    contracting    form 

of,  81. 

diagnosis  of,  84. 
Inflammatory  form  of,  75. 

diagnosis  of,  84,  86,  87. 
prognosis  of  acute,  89. 

chronic.  9.'{. 
treatment  of  acute,  90. 

chronij,  94. 

Bronchial  Tubes,  fragments  of  in  Sputum 
of  Phthisis,  207. 

29  (329) 


330 


INDEX. 


Bronchitis,  Sputum  in,  200,  215. 

Camera  Lucida,  38. 

method  of  using,  59. 
Cancer.    See  Tumors. 
Cancer  cells,  312. 

in  Urine,  126. 
in  Uterine  Cancer,  246. 
Carbolated  Syrup,  37. 
Carbonate  of  Lime  in  Urine,  114, 137. 
Carmine  Fluid  for  staining  tissues,  43. 
Cartilaginous  Tumors.    See  Tumors. 
Casts   of  Bright's   Disease.      See   Tube- 
Casts. 

Cell-walls  of  Red  Blood  Corpuscles,  176. 
Cements,  43. 

Hunt's,  43. 

Chancres,  Vibriones  in  Pus  of,  162. 
Chloasma,  278. 
Cholesteatoma,  319. 
Chromic    Acid    solution   for   hardening 

tissues,  309. 

Cilia  of  Epithelial  Cells,  245. 
Ciliary  movement,  245. 
COHNHEIM'S,     Prof.,    Doctrine     of    Pyo- 

genesis,  154. 

Author's  corroboration  of,  157. 
Colostrum  Corpuscles,  171. 
Compound  Microscope,  essentials  of,  10. 
Woodward's  Student's,  12. 
U.S.A.  Hospital,  16. 
Zentmayer's  Grand  American,  18. 
Compressorium,  or  Lever  Compressor,  40. 
Condensing  lens  (Bull's-eye  Condenser), 

13. 
Condyloma       resembling         malignant 

growth,  case  of,  321. 
Conical  glasses  for  reception  of  Urine, 

35. 

Coniferous  wood,  fibers  of,  in  Urine,  145. 
Cotton  fifcers  in  Urine,  144. 
Covers,  thin  glass,  for  objects,  34. 

cleansing  of,  34. 
Cutting  thin   sections   of  Tumors,   etc.. 

308,  309. 

Cystic  growths.    See  Tumors. 
Cystine,  137. 
Cystitis,  treatment  of,  120. 

DAVAINE,  M.,  on  Vibrioniens,  1C3. 
Deposits  from  Urine,  method  of  collect- 
ing, 68. 

varieties  of,  68. 
Diaphragm,  13. 

Diphtheria,  false  membrane  of,  170. 
nature  of,  170. 

Letzerich's  views,  171. 
Dissecting  Needles,  35. 
Dissecting  Scalpels,  Forceps,  etc.,  35. 
Drawing  magnified  objects,  59. 
Dumb-bell  Crystals  of  Oxalate  of  Lime, 
129. 

Ear,  Fungous  growths  in,  281. 
Elastic  Tissue  of  Lung  in  Sputum,  208. 
"  Embedding."  Strieker's  method  of,  309. 
Esitozoa  in  Urine,  139. 


Entozoa  in  Fecal  matters,  240. 
Epithelial  Cells,  examination  of,  47. 
Ether,  application  of,  under  Microscope, 

62,  307. 

Evaporating  Dish,  38. 
Examination    of     Objects    with      High 

Powers,  56. 

Immersion  Lenses,  57. 
Woodward's  Microscope,   45. 
Zentmayer's    Grand    Micro- 
scope, 55. 

Extraneous  matters  in  Urine,  142. 
Eye-pieces,  29. 

Kellner's  Orthoscopic,  31. 
Micrometer,  Cobweb,  30. 
simple,  30. 

FAGGE,  DR.  C.  II.,  Diagnosis  of  Scabies 

with  Eczema,  255. 
Fatty  Tumors.    See  Tumors. 
Favus,  diagnosis  of,  268. 
nature  of,  267. 
symptoms  of,  267. 
treatment  of,  270.  * 

Feather,  fragments  of,  in  Urine,  etc.,  145. 
FENWICK,    DR.    SAMUEL,     Oil    detecting 

Elastic  Tissue  in  Sputum,  204. 
Fibrin  filaments  in  Blood,  189. 
Fibrinous  Casts  of  Bronchial  Tubes,  173. 

in  Pneumonia,  200. 
Intestines,  237. 
Lacteal  Ducts,  173. 
Films  upon  Urine,  141. 
Flax  fibers  in  Urine,  144. 
FLEMING,  DR.  ANDREW,  on  Blood-Stains, 

294. 

FLINT,   PROF.  AUSTIN,  on  Bright's  Dis- 
eases, 89. 
Focusing,  50. 

Transitional,  50. 
Forceps  for  Dissecting,  35. 
Fox,    DR.   TILBURY,  on    Epiphytic    Dis- 
eases, 267. 

Fuchsine.    See  Aniline. 
Fungous  growths  in  Urine,  103. 

classification  of,  104. 
origin  of  Diseases,  168,  195, 252. 

Galactaemia,  189. 

GARRETSON,  PROF.  J.  E.,  Views  of  Aphtha, 

168. 
"  Germinal  Matter"  of  Beale,  179. 

of  Cattle  Plague,  194. 
Glycerin  for  mounting  objects,  42. 

Ilfcmatiuuria,  126. 
Hsematuria,  125. 

Intermittent  or  Epidemic,  126. 
Hsemato-Crystalline,  crystals  of,  176. 
Haemorrhagic  Diathesis,  diagnosis  of,  191. 
Hsemorrhaphilia,  191. 
Hardening      tissues    in     Alcohol     and 

Chromic  Acid,  309. 
Hair  in  Urine,  142. 
Halford's   "  Peculiar  Cells"  in   Blood  of 

Poisoned  Animals,  188. 
Ileterogenesis,  196. 


INDEX. 


331 


Heterogcnesis,  Dr.  Charlton  Bastian  on, 
197. 

HOUGH,  Da.  J.  STOCKTON,  on  Tru-hiniasiH, 
•Ji'.l.  ' 

Hu.v,  DR.  EDWARD  R.,  on  Trichiuiasis, 
•Jt»o,  -jr.r,. 

HUXLEY,  PROF.,  on  the  White  Blood  Cor- 
puscle as  Protoplasm,  155. 

Hydrocyanic  Acid,  detection  of,  304. 

Injecting  tissues,  method  of,  41. 
Intestinal  Worms,  240. 
Factitious.  -J  t'J. 
Iodine,  solution  of,  37. 

JACKSON,  DR.,  on  Trichiniasis,  259. 
"Juice"  of  Cancers,  examination  of,  307. 

Kidney,  Abscess  of,  119. 

Cancer  of,  126. 

Dilatation  of,  118. 

Tubercle  of,  119, 128. 
Kiestine,  141. 

KUCHENHEISTER  on  Trichomonaa  vagina- 
lis,  245. 

LEIDT,  PROF.  JOSEPH,  Diagnosis  of  pre- 
tended Trichina,  147,  266. 
Lenses,  Achromatic.    See  Objectives. 
cleansing  of,  58. 
explanation  of  apparent  magnifying 

power,  9. 

Leptothrix  buccalis,  53, 166. 
Leucine  in  Urine,  139. 
Leucocytes,  description  of,  95, 115. 
diagnosis  of,  160. 

Salivary  corpuscular  form  of,  115, 122. 
Leucocy  thffimia,  case  of  supposed,  186. 
causes  of,  184. 
definition  of,  182. 
investigation  for,  183. 
treatment  of,  185. 
Leucorrhosal  discharges,  246. 
LEWIS,  DR.  W.  B.,  on  Fungous  growths  in 

the  Ear,  281. 
Linear  Measurement,  22. 
Lithic  Acid.    See  Uric  Acid. 
Lithiuria,  nature  of,  134. 

treatment  of,  136. 

Lochial  discharges,  examination  of,  247. 
Lung-Tissue,   appearance  of,    in    Boiled 

Sputum,  208. 

objects    resembling,    in    Boiled 
Sputum,  211. 

McQuiLLEN,  PROF.    J.  H.,  Condition   of 

Blood  during  Anesthesia,  195. 
Maltwood's  Finder,  39. 
Measuring  Magnified  Objects,  60. 
Membranous  Casts.    See  Fibrinous  Casts. 
Method  of  Finding  Objects,  39. 
Examining  Objects,  45. 
Micrometer,  Cobweb  (Eye-piece),  30. 
Stage,  38. 

substitute  for,  39,  61. 
Microscope  Compound,  Army  Hospital, 
16. 


Microscope,  Binocular,  32. 

General  Principles  of,  10. 

(I'IHIIOW'B,  17. 

kinds  of   required    by    various 

classes,  11. 
McAllister's,  14. 
Makers  and  Dealers,  327. 
Tolles',  15, 18. 
Woodward's  Student's,  12. 
Zentmayer's  Grand  American,  19. 
Microscope,  Simple,  9. 
Microscopical  Examination,  method  of, 

with  High  Powers,  56. 
Microscopical  Examination,  method  of, 

with  Immersion  Lenses,  25,  57. 
Microscopical   Examination,  method  of, 

with  Woodward's  Microscope,  45. 
Microscopical  Examination,  method  of, 

with  /entinayer's  Microscope,  55. 
Microsporon  furfur,  description  of,  278. 
Milk  in  Urine,  146. 

examination  of,  171. 
constituents  of,  171. 
Morbid  Growths.    See  Tumors. 
Mounting  Objects  in  the  Dry  Way,  42. 

in  Glycerin,  42. 
Mucous  Corpuscles,  96, 163. 
Mucus,  Examination  of,  163. 
in  Urine,  96. 

Epithelial  Cells  of,  97. 
Vaginal,  244. 


Needles,  Mounted,  for  "  teasing"  out  tis- 
sues upon  a  Slide,  35. 

NIEMETER,  F.  VON,  views  of  Phthisis  and 
Tuberculosis.  221. 

Nitrate  of  Silver  Stainings,  method  for, 
44. 

NORRIS,  DR.  WM.  F.,  on  Gold  and  Silver 
Stainings,  44. 


Objectives,  advantages  of  high  power,  29. 

capacity  for  adjustment  of,  25. 

choice  of,  62. 

remarks  on  the,  21. 

cleaning  of,  58. 

defining  power  of,  24. 

flatness  of  field  of,  24. 

immersion,  25. 

magnifying  power  of,  22. 

mode  of  determining,  GO. 

penetrating  power  of,  24. 

Powell  &  Lealand's  One-fiftieth,  28. 

Table  of  Magnifying  Powers  of,  23. 

tests  for,  53,  62. 

Tolles'  One-tenth,  26. 

Wales'  One  Twenty-fifth,  27. 
Oidium  Albicans,  166. 
Oil  Globules,  appearance  of,  146. 
Oligocythffimia,  186. 
Oxalate  of  Lirne,  appearance  of,  128. 
Oxaluria,  different  views  in  regard  to,  130. 

treatment  of,  146. 

Oxyuris  vermicularis,  description  of,  241. 
ova  of,  241. 


332 


INDEX. 


Photo-micrography,  Dr.  Woodward's  Re- 
port on,  60. 

Phthisis,  diagnosis  of,  by  Lung-Tissue  in 
Sputum,  208. 

Acute,  diagnosis  of  case,  222. 
Pipettes,  mode  of  making,  36. 
Polarized  Light,  apparatus  for  using,  65. 
Polycytheemia,  186. 

Preservation  of  Objects  in  Glycerin,  42. 
Pressure  Test  for  Tube-Casts,  142. 
Pus  of  Chancres,  Vibriones  in,  162,  248. 

examination  of,  158,  162. 

in  Urine,  114. 

clinical  importance  of,  116. 

origin  of,  according  to  Cohnheim,  154. 

tests  for,  114. 

varieties  in  Corpuscles  of,  162. 
Pus  Corpuscles.    See  Leucocytes. 
Pyelitis,  diagnosis  of,  118. 

Rape,  case  of  supposed,  299. 
Red  Blood  Corpuscles  in  Urine,  85, 121. 
diagnostic  value  of,  125. 

Bright's  Disease,  124. 
Reagents  necessary,  37. 

application  of,  beneath   the   Micro- 
scope, 62. 

Ringworm.    See  Tsenia. 
ROOSA,  DR.  ST.  JOHN,  on  Fungous  Growth 
in  the  Ear,  281. 

SALISBURY,  PROP.  J.  H.,  on  Fibrin  Fila- 
ments in  Blood,  189. 
Saliva,  Epithelial  Cells  in,  47, 164. 

investigation  of,  45,  164. 
Silivary  Corpuscles,  description  of,  164. 
as  test  oljects,  53. 
origin  of,  166. 
Salivary  Corpuscular  form  of  Leucocytes, 

115,  157. 

Sarcina  ventriculi  in  Vomit,  231. 
nature  of,  232. 
symptoms  of,  231. 
treatment  of,  233. 
in  Urine,  105. 
Sarcoma  of  Virchow,  315. 
Scabies,  case  of,  253. 
diagnosis  of,  254. 

importance  of  accuracy  in,  253. 
old  views  in  regard  to,  252. 
symptoms  of,  254. 
treatment  of,  257. 
Scall-head.    See  Favus. 
Scalpels  for  dissecting,  35. 
Section  Cutter,  use  of,  309. 
Sections,  thin,  of  Tumors,  modes  of  pre- 
paring. 308,  309. 
Rokitansky's,  309. 
Strieker's,  309. 
Silica  in  Urine,  139. 
Silk  Fibers  in  Urine,  144. 
Simple  Microscope,  9. 
SIMS,  DR.  J.  MARION,  method  for  diagnosis 

of  Sterility,  248. 
Slides,  Glass,  33. 
Soda,  solution  of  Caustic,  38. 
Soft  Tissues,  cutting  thin  sections  of,  309. 


SORLY,  H.  C.,  on  Spectrum  Analysis,  66. 

of  Blood-Stains,  297. 
Spermatorrhoea,  102. 

in  Seminal  Stains,  300. 

Urine,  99. 
Spots  on  Glass  Slides,  146. 

on  the  Eye-piece,  to  detect,  48. 
Sputum,  accidental  ingredients  of,  198. 
examination  of,  199. 
of  Bronchitis,  200,  215. 
Haemoptysis,  202. 

pretended,  203. 
Hydrophobia,  200. 
Phthisis,  204. 

appearance  of   Lung-Tissue 

in,  208. 
diagnostic  value  of,  213. 

statistics  in  regard 

to,  215. 

Phthisis,  investigation  of,  206. 
preparation  of,  for  examina- 
tion, 205. 
recognition  of   Lung-Tissue 

in,  209,  210. 
Pneumonia,  200. 
Rupture  of  the  Lung,  202. 
Spectre-Microscope,  66. 
Spermatic  Fluid,  examination  of,  249. 

value  of,  251. 

Squamous  Epithelial  Cells,  47. 
Stage  Micrometer,  38,61. 
Starch  Granules  in  Urine,  146. 
Stains  of  Blood.    See  Blood-Stains. 
Stains  of  Spermatic  Fluid,  case  of,  299. 
examination  of,  300. 

method  of  Caspar,  301. 

Briand,302. 
varieties  of,  303. 
discrimination  among,  304. 
Staining  Tissues,  Beale's  Carmine  method, 

43. 

Cohnheim's  Gold  method,  44. 
Recklinghausen's  Silver  method, 

44. 

Sterility,  case  of,  251. 
diagnosis  of,  248. 
STILES,  DR  It.  CRESSON,  on  Favus   in  the 

Mouse,  277. 
Sugar  Fungus  in  Urine,  104. 

Tomia  solium,  242. 
ova  of,  242. 

Tartar  of  the  Teeth,  nature  of,  169. 
Test  Objects,  63. 

for  High  Powers,  64. 
Thin  glass  covers,  34. 
Tinea  circinata,  description  of,  275. 
diagnosis  of,  275. 
treatment  of,  277. 
sycosis,  description,  etc.,  276. 
tonsurans,  description,  etc.,  273. 
versicolor,  description,  etc.,  278. 
Torula  in  Urine,  104. 
Trichina  spiralis,  description  of,  262. 

diagnosis  of,  from  Vinegar   Eel, 

147,  266. 
mode  of  detecting,  261. 


INDEX. 


333 


Trichiniasis,  diagnosis  of,  261. 
history  of  discovery,  '259. 
symptoms  of.  -\>o. 
treatment  of,  266. 
Trirhomonas  vaginalis,  244. 
Tricopliyton,  274. 
Triple  Phosphates  in  Urine,  109. 

Clinical  significance  of,  111. 
Tube-casts,  Clinical  importance  of    dif- 
ferent kinds,  82. 
diagnosis  of,  71,  142. 
varieties  of,  70. 

"  Tubercle  Corpuscles,"  description  of,  128. 

Tumors  composed  of  Adenoid  tissue,  318. 

of  Colloid  growth,  314. 

Cystic  growth.  :;is. 

growth  (Proliferous),  318. 
Encephaloid  cancer,  312. 
Epithelial  growth,  317. 
Erectile  tissue,  318. 
Fatty  growth  (Lipoma),  319. 
Fibrous  growth,  317. 
Ffbro-cystic  growth,  318. 
Myeloid  tissue,  314. 
Melanotic  growth,  319. 
Neuromatous  growth,  318. 
Kecurreut     Fibroid     growth, 

316. 

Scirrhous  cancer,  313. 
Sebaceous  deposit,  319. 
Steatomatous  deposit,  319. 
Tubercular  deposit,  311. 
cutting  sections  of,  308,  309. 
Malignant,  Microscopical  characters 

of,  320. 

Fatty  degeneration  in  cells  of,  322. 
illustrative  case  of,  320. 

of  suspected,  321. 
Mother-cells  in.  323. 
Multi-nucleated  cells  in,  323. 
variety  of  cell-shapes  in,  321. 
Microscopical   Examination  of,  diffi- 
culties in,  306. 
preparation  for,  307. 
value  of,  305. 
Prognosis  of,  324,  325. 
Tyrosin  in  Urine,  139. 
TYSON.  PROF.  JAMES,  on  Germinal  Matter 
of  \Vliite  Blood  Corpuscles,  180. 


Urate  of  Soda,  globules  of,  141. 
Urates,  Amorphous,  in  Urine,  107. 

importance  of,  109. 
Uric  Acid  in  Urine,  132. 

Solvent  treatment  for  calculi  of, 

136. 
Urine,  Chylous,  140. 

classification  of  deposits  from,  68. 
collection  for  Examination,  67. 
Extraneous  matters  in,  modes  of  de- 
tecting, 142. 

Method  of  Examination,  68. 
Table  for  systematic  Examination  of, 

147-152. 

Uro-steahth,  141. 
Uterus,  Diagnosis  in  Cancer  of,  246. 

Valentine's  Knife,  39. 

Venom-Poisoning,    Halford's    "Peculiar 

Cells"  in,  188. 
Vibrioues  in  Chancrous  Pus,  162,  248. 

in  Urine,  104. 
Vine  Fungus,  168. 
Vinegar  Eels  in  Urine,  147. 

plant,  104. 

Vomit,  "coffee-ground,"  226. 

constituents  of,  225. 

containing  Oidium  albicans,  230. 

Sarcina,  231. 

Torula,  229. 

Examination  of,  224. 

case  illustrating  value  of.  223. 
in  Cancer  of  the  Stomach,  227. 
in  Ulcer  of  the  Stomach,  227. 

White  Blond  Corpuscles.     See  Blood. 

Wood,  fibers  of,  in  Urine,  145. 

WOOD,  PROF.  II.  C.,  Parasitic  Origin  of 
Diseases,  195. 

WOODWARD,  COL.  J.  J.,  on  Photo-microg- 
raphy, 66. 

Working  Glas*,  nude  of,  36. 

WORMLEY,  PROF.  THEODORE,  on  the  Micro- 
chemistry  of  Poisons,  304. 

Xanthine  or  Xanthic  Oxide  in  Urine.  138. 

Yeast-plant,  growth  of,  105,  229. 
in  Urine,  104. 


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